Understanding the association between stunting and child development in low- and middle-income countries: Next steps for research and intervention

Perkins, Jessica M.; Kim, Rockli; Krishna, Aditi; McGovern, Mark E.; Aguayo, Víctor M.; Subramanian, S. V.

doi:10.1016/j.socscimed.2017.09.039

Cited by 129 publications

(129 citation statements)

References 131 publications

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“…Among limitations of this study is the cross‐sectional nature of the data, making it not possible to infer causality or mediation in the observed associations between child undernutrition and development indicators. It remains to be causally established that linear growth deceleration leading to stunting may adversely affect child development (Larson & Yousafzai, ; Perkins et al, ). Our analysis included four South Asian countries where MICS‐Round 4 or 5 was conducted.…”

Section: Discussionmentioning

confidence: 99%

Association between stunting and early childhood development among children aged 36–59 months inSouth Asia

Kang

Aguayo

Campbell

et al. 2018

Maternal & Child Nutrition

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Stunting (length‐for‐age z score < −2) before 2 years of age has shown associations with poor child developmental indicators, but information at the population level is scarce in South Asia, the region with the highest burden of stunting. We examined associations between z scores (i.e., height for age [HAZ], weight for age [WAZ], and weight for height [WHZ]) and undernutrition (i.e., stunting [HAZ < −2], wasting [WHZ < −2], and underweight [WAZ < −2]) with learning/cognition and social–emotional development among children 36–59 months of age. Data from Multiple Indicator Cluster Surveys in Bangladesh ( n = 8,659), Bhutan ( n = 2,038), Nepal ( n = 2,253), and Pakistan (Punjab n = 11,369 and Sindh n = 6,718) were used. Children were considered developmentally “on‐track” in learning/cognition or social–emotional domains if they met specific early child development criteria. Meta‐analysis was conducted to examine regional associations, adjusting for socio‐economic status, early childhood education, and quality of care. In a pooled sample, on‐track learning/cognition development was positively associated with HAZ ( OR = 1.17, 95% CI [1.07, 1.27]) and WAZ ( OR = 1.18, 95% CI [1.07, 1.31]) and negatively associated with stunting ( OR = 0.72, 95% CI [0.60, 0.86]) and underweight ( OR = 0.75, 95% CI [0.66, 0.86]) but not associated with WHZ or wasting. On‐track development of social–emotional domain was not associated with any z scores or undernutrition indicators. Across several countries of South Asia, stunted children were less likely to be developmentally “on track” for learning/cognition. It is likely that interventions that prevent stunting may benefit child development, leading to significant individual and societal gains given the large burden of child stunting in regions like South Asia.

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Section: Discussionmentioning

confidence: 99%

Association between stunting and early childhood development among children aged 36–59 months inSouth Asia

Kang

Aguayo

Campbell

et al. 2018

Maternal & Child Nutrition

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“…Stunting (length‐for‐age measured at 2 standard deviations below the World Health Organization (WHO)‐established median) prior to 24 months of age has been associated with poor school performance (Sudfeld, Charles McCoy, Danaei, Fink, Ezzati, Andrews, & Fawzi, ), reduced economic income during adulthood (Hoddinott, Alderman, Behrman, Haddad, & Horton, ), and both low birth weight and poor cognitive performance in the subsequent generation (Victora, de Onis, Hallal, Blossner, & Shrimpton, ; Walker, Chang, Wright, Osmond, & Grantham‐McGregor, ). Although the association between stunting and child development has been demonstrated across multiple sites and study designs (Machin, Day, & Green, ; Miller, Murray, Thomson, & Arbour, ; Sudfeld et al ., ), there is no consensus on the mechanisms linking stunting and children's development (Perkins, Kim, Krishna, McGovern, Aguayo, & Subramanian, ). Possible mechanisms include neurological, hormonal, infection, stress, and functional isolation, as well as combinations or interactions among mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms linking height to early child development among infants and preschoolers in rural India

Black

Yimgang

Hurley

et al. 2019

Developmental Science

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Stunting has been negatively associated with children's development. We examined the range of height by testing hypotheses: (a) height is positively associated with children's development, with associations moderated by inflammation and (b) home environments characterized by nurturance and early learning opportunities is positively associated with children's development over time and attenuate associations with height. Data included 513 infants (mean age 8.6 months) and 316 preschoolers (mean age 36.6 months) in rural India from a randomized controlled trial of multiple micronutrient powders (MNPs). Measures included height (height‐for‐age z‐scores based on WHO standards), inflammation (C‐reactive protein concentration >5 mg/L), nurturance (HOME Inventory), child development (Mullens Scales of Early Learning), and inhibitory control (preschoolers). Linear mixed effects models accounting for repeated measures, clustering, and confounders were used to assess associations between height and child development over time (infants: enrollment, 6 and 12 months; preschoolers: enrollment and 8 months). Moderating effects of inflammation and nurturance were tested with interaction terms. Among infants and preschoolers, height and nurturance were positively associated with all domains of child development over time, with the exception of inhibitory control. Among preschoolers, in the presence of inflammation, height was not associated with child development. Among infants, but not preschoolers, a nurturant home environment attenuated significant associations between height with fine motor and receptive language development. The mechanisms associated with children's development over time are multifactorial and include direct and indirect associations among nutrition, health, and the home environment, as supported by the Nurturing Care Framework.

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“…This has significant impact on individuals’ quality of life, as well as the nation's workforce and economic development (Alderman, Behrman, Grantham‐McGregor, Lopez‐Boo, & Urzua, ). Multiple interventions have attempted to improve cognitive outcomes of children who are at‐risk, which have had varied effectiveness (for review, see Perkins et al., ). Discrepancies are likely due to outstanding questions about the nature and trajectory of compromised cognitive development in LMICs.…”

Section: Introductionmentioning

confidence: 99%

Adaptation of the Mullen Scales of Early Learning for use among infants aged 5‐ to 24‐months in rural Gambia

Milosavljevic

Vellekoop²,

Maris

et al. 2019

Developmental Science

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Infants in low‐resource settings are at heightened risk for compromised cognitive development due to a multitude of environmental insults in their surroundings. However, the onset of adverse outcomes and trajectory of cognitive development in these settings is not well understood. The aims of the present study were to adapt the Mullen Scales of Early Learning (MSEL) for use with infants in a rural area of The Gambia, to examine cognitive development in the first 24‐months of life and to assess the association between cognitive performance and physical growth. In Phase 1 of this study, the adapted MSEL was tested on 52 infants aged 9‐ to 24‐months (some of whom were tested longitudinally at two time points). Further optimization and training were undertaken and Phase 2 of the study was conducted, where the original measures were administered to 119 newly recruited infants aged 5‐ to 24‐months. Infant length, weight and head circumference were measured concurrently in both phases. Participants from both phases were split into age categories of 5–9 m (N = 32), 10–14 m (N = 92), 15–19 m (N = 53) and 20–24 m (N = 43) and performance was compared across age groups. From the ages of 10–14 m, Gambian infants obtained lower MSEL scores than US norms. Performance decreased with age and was lowest in the 20–24 m old group. Differential onsets of reduced performance were observed in the individual MSEL domains, with declines in visual perception and motor performance detected as early as at 10–14 months, while reduced language scores became evident after 15–19 months of age. Performance on the MSEL was significantly associated with measures of growth.

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Understanding the association between stunting and child development in low- and middle-income countries: Next steps for research and intervention

Cited by 129 publications

References 131 publications

Association between stunting and early childhood development among children aged 36–59 months inSouth Asia

Association between stunting and early childhood development among children aged 36–59 months inSouth Asia

Mechanisms linking height to early child development among infants and preschoolers in rural India

Adaptation of the Mullen Scales of Early Learning for use among infants aged 5‐ to 24‐months in rural Gambia

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