Early childhood growth and cognitive outcomes: Findings from the MAL‐ED study

Although many studies around the world hope to measure or improve developmental progress in children to promote community flourishing and productivity, growth is sometimes used as a surrogate because cognitive skills are more difficult to measure. Our objective was to assess how childhood measures of anthropometry correlate with measures of child development in low‐income settings with high prevalence of poor nutrition and enteric disease, to inform studies considering growth outcomes in the absence of direct child developmental skill assessment. Children from the MAL‐ED study were followed from birth to 24 months of age in field sites in 8 low‐ and middle‐income countries across 3 continents. Monthly weight, length, and head circumference measurements were performed. At 24 months, the Bayley Scales of Infant and Toddler Development was administered. We correlated cognitive measures at 24 months with anthropometric measurements from birth to 2 years comparing 3 constructs: absolute attained monthly measures, summative difference in measures from the mean growth curve, and rate of change in measures. Growth faltering at multiple time periods is related to Bayley cognitive outcomes at 24 months. Birthweight, overall growth by 18–24 months, and rate of growth in the 6‐ to 18‐month period were most associated with 24‐month developmental scores. In this study, head circumference measurements, compared with length, was more closely linked to cognitive scores at 24 months. Notably, all studies between growth and cognitive outcomes exhibited low r² values (0.001–0.049). Anthropometric measures, particularly head circumference, were related to cognitive development, although explaining a low percent of variance. When feasible, direct measures of child development may be more useful.     

How multiple episodes of exclusive breastfeeding impact estimates of exclusive breastfeeding duration: report from the eight‐site MAL‐ED birth cohort study

The duration of exclusive breastfeeding (EBF) is often defined as the time from birth to the first non‐breast milk food/liquid fed (EBFLONG), or it is estimated by calculating the proportion of women at a given infant age who EBF in the previous 24 h (EBFDHS). Others have measured the total days or personal prevalence of EBF (EBFPREV), recognizing that although non‐EBF days may occur, EBF can be re‐initiated for extended periods. We compared breastfeeding metrics in the MAL‐ED study; infants' breastfeeding trajectories were characterized from enrollment (median 7 days, IQR: 4, 12) to 180 days at eight sites. During twice‐weekly surveillance, caretakers were queried about infant feeding the prior day. Overall, 101 833 visits and 356 764 child days of data were collected from 1957 infants. Median duration of EBFLONG was 33 days (95% CI: 32–36), compared to 49 days based on the EBFDHS. Median EBFPREV was 66 days (95% CI: 62–70). Differences were because of the return to EBF after a non‐EBF period. The median number of returns to EBF was 2 (IQR: 1, 3). When mothers re‐initiated EBF (second episode), infants gained an additional 18.8 days (SD: 25.1) of EBF, and gained 13.7 days (SD: 18.1) (third episode). In settings where women report short gaps in EBF, programmes should work with women to return to EBF. Interventions could positively influence the duration of these additional periods of EBF and their quantification should be considered in impact evaluation studies. © 2016 John Wiley & Sons Ltd     

Individual and contextual factors associated with childhood stunting in Nigeria: a multilevel analysis

Stunting, a form of undernutrition, is the best measure of child health inequalities as it captures multiple dimensions of children's health, development and the environment where they live. The aim of this study was to quantify the predictors of childhood stunting in Nigeria. This study used data obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). A total of 28 647 children aged 0–59 months included in NDHS in 2008 were analysed in this study. We applied multilevel multivariate logistic regression analysis in which individual‐level factors were at the first level and community‐level factors at the second level. The percentage change in variance of the full model accounted for about 46% in odds of stunting across the communities. The present study found that the following predictors increased the odds of childhood stunting: male gender, age above 11 months, multiple birth, low birthweight, low maternal education, low maternal body mass index, poor maternal health‐seeking behaviour, poor household wealth and short birth interval. The community‐level predictors found to have significant association with childhood stunting were: child residing in community with high illiteracy rate and North West and North East regions of the country. In conclusion, this study revealed that both individual‐ and community‐level factors are significant determinants of childhood stunting in Nigeria.     

Malnutrition matters: Association of stunting and underweight with early childhood development indicators in Nepal

Malnutrition is a threat to optimal child development, with its occurrence during foetal and infancy stages associated with poor cognitive, motor and socio‐emotional skills. However, information on the effects of various types of malnutrition on early childhood development (ECD) is limited in Nepal. To assess the association of stunting, wasting and underweight (three prominent forms of malnutrition) with the four domains of the ECD index (literacy‐numeracy, physical, social‐emotional and learning development) among children 36–59 months of age, we conducted an adjusted logistic regression using Nepal''s national household Multiple Indicator Cluster Survey (MICS) 2019 data set. The study sample consisted of children aged 36–59 months (n = 2871). Children were considered developmentally on track if they met criteria in each of the four ECD domains. Regarding ECD status of children 36–59 months old, 35% of children were not developmentally on track for the ECD index. The adjusted odds ratio indicated that stunting was associated with lower odds of not being developmentally on track according to the ECD index as well as the literacy‐numeracy, physical and learning domains of the ECD index. Likewise, underweight was associated with lower odds of not being developmentally on track according to the ECD index, primarily for ECD domains of literacy‐numeracy, physical and learning. Notably, no association between wasting and ECD indicators was observed. Children''s nutrition status impacts child development outcomes. Adding ECD interventions, such as responsive and stimulating caregiving, within nutrition programmes among children who are stunted and underweight could improve child development outcomes.     

Early wheezing phenotypes and cognitive development of 3‐yr‐olds. Community‐recruited birth cohort study

Jedrychowski W, Perera FP, Jankowski J, Maugeri U, Mrozek‐Budzyn D, Mroz E, Flak E, Skarupa A, Edwards S, Lisowska‐Miszczyk I. Early wheezing phenotypes and cognitive development of 3‐yr‐olds. Community‐recruited birth cohort study.
Pediatr Allergy Immunol 2010: 21: 550–556.
© 2009 John Wiley & Sons A/S The main purpose of the study was to answer the question whether young children without clinical diagnosis of asthma but experiencing early wheezing disorders and therefore being at high risk of developing asthma may have cognitive deficits. In the ongoing birth cohort study wheezing symptoms were recorded postpartum over two first years of age and subsequently cognitive status of children at the age of 3 yr was assessed with the Bayley Mental Development Index (MDI). In the statistical analysis a wide range of modifying and confounding factors (maternal education, gender of children, prenatal exposure to lead and environmental tobacco smoke (ETS) were considered to assess the independent effect of early wheezing phenotypes on cognitive development of children. The MDI score correlated inversely with the number of wheezing days recorded over 24 months (r = ?0.13, p = 0.007), lead cord blood concentration (r = ?0.12, p = ?0.02), number of siblings (r = ?0.17, p = 0.0006) and the number of cigarettes smoked daily by other household members at home over the pregnancy period (r = ?0.18, p = 0.0002). While the children who experienced wheezing over the first year of age showed deficit of 2 MDI scores (beta coeff. = ?2.31, 95%CI: ?4.63 to 0.02), those with persistent wheezing had the score deficit of 4 points (beta coeff. = ?4.41, 95%CI: ?8.27 to ?0.55). To our knowledge, it is the first report in the iterature showing that early wheezing is associated the cognitive deficit in a community‐recruited very young children. Observed cognitive deficit in early wheezers may be caused by RSV infections or can be related to lower lung function attributed to persistent wheezing, which reducing oxygen supply would affect rapidly developing brain.     

Stunting,recovery from stunting and puberty development in the MINIMat cohort,Bangladesh

Aim

This paper aimed to analyse the association between small for size at birth, stunting, recovery from stunting and pubertal development in a rural Bangladeshi cohort.

Methods

The participants were 994 girls and 987 boys whose mothers participated in the Maternal and Infant Nutrition Interventions in Matlab trial. The birth cohort was followed from birth to puberty 2001-2017. Pubertal development according to Tanner was self-assessed. Age at menarche was determined and in boys, consecutive height measurements were used to ascertain whether pubertal growth spurt had started. The exposures and outcomes were modelled by Cox’s proportional hazards analyses and logistic regression.

Results

There was no difference in age at menarche between girls that were small or appropriate for gestational age at birth. Boys born small for gestational age entered their pubertal growth spurt later than those with appropriate weight. Children who were stunted had later pubertal development, age at menarche and onset of growth spurt than non-stunted children. Children who recovered from infant or early childhood stunting had similar pubertal development as non-stunted children.

Conclusion

Infant and childhood stunting was associated with a later pubertal development. Recovery from stunting was not associated with earlier puberty in comparison with non-stunted children.

     

Early childhood development: A comparative study of beliefs held by adolescents, medical students and mothers

Abstract This study examined beliefs about the normal development of preschool children held by adolescents, medical students and mothers. A consistent pattern was identified, with adolescents estimating that young children can do the least, medical students'estimations lying between those of adolescents and mothers, and mothers estimating that the children can do the most. In addition, medical students were found to change their beliefs during the time that they participated in their paediatric teaching programme. It is suggested that paediatricians and other child health professionals take into account the varying beliefs held by different groups in the community when providing advice or teaching about early child development.     

Prevalence and correlates of the composite index of anthropometric failure among children under 5 years old in Bangladesh

The prevalence of stunting, wasting, and underweight are reported separately. However, the data of the multiple anthropometric failures combinations of these conventional indicators are scant. This study attempted to estimate the overall burden of undernutrition among children under 5 years old, using the composite index of anthropometric failure (CIAF), and to explore the correlates. The study used secondary data from the Bangladesh demographic and health surveys (BDHS), undertaken in 2014. CIAF provides an overall prevalence of undernutrition, which gives six mutually exclusive anthropometric measurements of height‐for‐ age, height‐for‐weight, and weight‐for‐age. Multivariable logistic regression was used to explore the correlates of CIAF. The overall prevalence of undernutrition using the CIAF was 48.3% (95% CI [47.1%, 49.5%]) among the children under 5 years old. The prevalence of anthropometric failure due to a combination of both stunting and underweight was 18.2%, wasting and underweight was 5.5%, and wasting, underweight, and stunting was 5.7%. The odds of CIAF were higher among young maternal age, having the poorest socio‐economic status, living in rural areas, higher order of birth, and received no vaccination compared with other counterparts. In Bangladesh, one out of two children has undernutrition, which is preventing the potential of the millions of children. Mothers who gave birth before age 20 living in the rural areas with belonging to lower socio‐economic status and whose children had a higher order of birth and receive no vaccination were observed as the main determinants of undernutrition. Nutrition sensitive interventions along with social protection programmes are crucial to deal the underlying causes of undernutrition.     

Timing,intensity, and duration of household food insecurity are associated with early childhood development in Kenya

This study examines the association between 3 dimensions of food insecurity (timing, intensity, and duration) and 3 domains of child development (gross motor, communication, and personal social). Longitudinal data from 303 households (n = 309 children) visited 9 times over 2 years were collected. Children in households experiencing severe food insecurity 3 months prior (timing) had significantly lower gross motor (β ?0.14; 95% CI [0.27, ?0.0033]; p = .045), communication (β ?0.16; 95% CI [?0.30, ?0.023]; p = .023), and personal social (β ?0.20; 95% CI [?0.33, ?0.073]; p = .002) Z‐scores, using lagged longitudinal linear models controlling for current food insecurity; these results were attenuated in full models, which included maternal education, household asset index, and child anthropometry. Children in households that experienced greater aggregate food insecurity over the past 2 years (intensity) had significantly lower gross motor (β ?0.047; 95% CI [?0.077, ?0.018]; p = .002), communication (β ?0.042; 95% CI [?0.076, ?0.0073]; p = .018), and personal social (β ?0.042; 95% CI [?0.074, ?0.010]; p = .010) Z‐scores; these results were also attenuated in full models. Children with more time exposed to food insecurity (duration) had significantly lower gross motor (β ?0.050; 95% CI [?0.087, ?0.012]; p = .010), communication (β ?0.042; 95% CI [?0.086, 0.0013]; p = .057), and personal social (β ?0.037; 95% CI [?0.077, 0.0039]; p = .076) Z‐scores; these results were no longer significant in full models. Our findings suggest that acute and chronic food insecurity and child development are related, but that many associations are attenuated with the inclusion of relevant covariates.     

Determinants of mental and motor development at 12 months in a low income population: a cohort study in northeast Brazil

AIM: To identify biological and environmental factors associated with poorer mental and motor development at age 12 mo in urban communities in northeast Brazil. METHODS: A cohort of 245 infants born during January August 1998 in six hospitals in the interior of Pernambuco was followed twice weekly from birth until 12 mo of age. Socio-economic, demographic and environmental data were collected, together with daily information on morbidity and feeding patterns. Gestational age, birth anthropometry and nutritional status at 12 mo were measured. Multiple linear regression analysis was used to identify variables that had independent effects on mental and motor development assessed at 12 mo of age with the Bayley Scales of Infant Development. RESULTS: Environmental factors explained about 21% and 19% of the variance in mental and motor development, respectively. Of these, the most important were poverty-related. Significant biological factors associated with mental development were birthweight and infant sex. For motor development, the biological factors were weight-for-age and haemoglobin concentration. Biological factors explained only 6% and 5% of the variance in mental and motor development, respectively. CONCLUSION: Of the variables examined, environmental factors had a greater detrimental effect on child development than biological factors in this population. Interventions that enhance social capital and alleviate poverty are advocated.     

Severely inadequate micronutrient intake among children 9–24 months in Nepal—The MAL‐ED birth cohort study

Prevalence of micronutrient deficiencies is high among infants and children in low‐ and middle income countries, but knowledge about nutrient adequacy across the complementary feeding period is limited. We investigated probability of adequacy (PA) of breast milk and complementary food combined and nutrient density adequacy (NDA) of complementary food and tracking of NDA over time among 229 children from 9–24 months of age in Bhaktapur, Nepal. Monthly, 24 h dietary recalls (16 in total) were performed and subgrouped into four 4‐month time periods. Ten micronutrients (thiamin, riboflavin, niacin, vitamin B₆, folate, vitamin C, vitamin A, calcium, iron, and zinc) were assessed. Nutrient density was defined as the amount of a nutrient in a child's complementary food per 100 kcal, whereas NDA was the nutrient density as percentage of the context specific desired nutrient density. Tracking of NDA was investigated using generalized estimating equations models. PA for B vitamins (except riboflavin), vitamin A, calcium, iron, and zinc (low absorption group) was very low (0% to 8%) at all time slots. Median (IQR) mean PA (of all 10 micronutrients) increased from 11% (9, 15) in the second to 21% (10, 35) in the last time slot. Median value for mean nutrient density adequacy of all micronutrients varied between 42% and 52%. Finally, tracking of NDA was low (correlation <0.30) or moderate (0.30–0.60) indicating poor association between the first and subsequent measurements of NDA. These findings raise grave concerns about micronutrient adequacy among young children in Nepal. Urgent interventions are needed.     

Determinants of child stunting in the Royal Kingdom of Bhutan: an in‐depth analysis of nationally representative data

Stunting is associated with poor survival and development in children. Our analysis identifies the factors most significantly associated with child stunting in Bhutan using a nationally representative sample of 2085 children 0–23 months old. We find that 27.5% of children were stunted and almost half (42.6%) of the stunted children were severely stunted. Children's mean height‐for‐age z‐score deteriorated significantly with age (from ?0.23 in infants 0–5 months old to ?1.60 in children 18–23 months old) and levels of severe stunting were significantly higher among boys. Multivariate regression analysis indicates that children from the Eastern/Western regions had a 64% higher odds of being stunted than children from the Central region (OR 1.64; 95% CI 1.29–2.07); similarly, children from the two lower wealth quintiles had 37% higher odds of being stunted than children from the two upper wealth quintiles (OR 1.37; 95% CI 1.00–1.87). Children whose mothers received three or fewer antenatal care visits during the last pregnancy had a 31% higher odds of being stunted (OR 1.31; 95% CI 1.01–1.69) while children whose mothers did not receive antenatal care from a doctor, nurse or midwife had a 51% higher odds of being stunted (OR 1.51; 95% CI 1.18–1.92). Recommended complementary feeding practices tended to be associated with lower odds of stunting, particularly in the first year of life. Specifically, children who were not fed complementary foods at 6–8 months had about threefold higher odds of being severely stunted than children who were fed complementary foods (OR 2.73; 95% CI 1.06–7.02).     

Household food insecurity and early childhood development: Systematic review and meta‐analysis

Household food insecurity (HFI) is a powerful stressor negatively associated with early childhood development (ECD). However, no comprehensive review has examined the association of HFI and ECD. Therefore, this systematic review and meta‐analysis investigated the association between HFI and ECD domains and subdomains in children under 5 years old. Peer‐reviewed and grey literature were systematically searched in electronic databases with no year or language restrictions. Studies were eligible if they assessed the association between HFI and one or more ECD domains. Data were extracted using a standard predefined protocol. Meta‐analysis was performed, and the heterogeneity across studies was explored. Nineteen studies were included in the systematic review and 14 in the meta‐analysis. Of the studies, 15 were from high income countries (HICs) and four from low–middle income countries (LMICs). For developmental risk and the cognitive/math and cognitive/school readiness and reading subdomains, the only studies available were conducted in HICs. The meta‐analysis showed that HFI was associated with developmental risk (OR 1.28; 95% CI [1.14, 1.45]), cognitive/vocabulary (OR 0.94; 95% CI [0.90, 0.98]), and cognitive/math (OR 0.84; 95% CI [0.73, 0.96]). HFI was marginally associated with cognitive/school readiness and reading (OR 0.91; 95% CI [0.82, 1.00]) and motor development (OR; 0.91, 95% CI [0.80, 1.04]). HFI was associated with poor ECD in children under 5 years old. Specifically, HFI was associated with developmental risk and poor math skills in studies conducted in HICs and with poor vocabulary skills in studies conducted in both HICs and LMICs. Prospective studies examining HFI and ECD are needed in LMICs.     

Evolution of infant feeding practices in children from 9 to 24 months,considering complementary feeding indicators and food processing: Results from the Brazilian cohort of the MAL‐ED study

Infant feeding practices impact children''s nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods.