Early childhood undernutrition, preadolescent physical growth, and cognitive achievement in India: A population-based cohort study.
Early childhood undernutrition, preadolescent physical growth, and cognitive achievement in India: A population-based cohort study.
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DOI：
10.1371/journal.pmed.1003838
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发表时间：
2021-10
期刊：
影响因子：
15.8
通讯作者：
Allison JJ
中科院分区：
文献类型：
--
作者：
Soni A;Fahey N;Bhutta ZA;Li W;Frazier JA;Moore Simas T;Nimbalkar SM;Allison JJ
在印度，关于幼儿营养不良对青春期前结果的影响，缺乏具有全国代表性的估计。了解这种关系有助于制定干预措施，不仅防止儿童营养不良，而且减轻其后果。在这项队列研究中，我们分析了从印度人类发展调查（IHDS）的2波前瞻性收集的数据，以调查2004年至2005年儿童早期（0至5岁）营养不良与2011年至2012年青春期前（8至11岁）的身体和认知结果之间的关系。这些调查在2004年至2005年访问了印度所有33个邦和中央直辖区的41，554户家庭，并在2011年至2012年重新访问了83%的家庭。根据2004年至2005年的调查，使用人体测量失败综合指数（CIAF）评估原发暴露。根据2011年至2012年的调查，主要结局是青春期前的身材矮小（年龄别身高z评分[HAZ] <-2）、消瘦（体重指数[BMI] <18.5 kg/m2）、阅读和算术技能。使用调查加权广义线性模型，并使用3向相互作用项评估基于儿童性别和社会人口学变量的效应修正。在这项分析所包括的7 868名儿童中，有4 334名（57.3%）营养不良。营养不良与身材矮小的几率增加有关（比值比[OR] 1.73，95%置信区间[CI] 1.45 - 2.06）和瘦（OR 1.52，95%CI 1.33至1.73），而它与实现较高阅读的几率降低相关（累积比值比[cumOR]：0.76，0.66至0.87）和算术（cumOR：0.72，0.63至0.82）结果。基于CIAF的结果差异随着年龄的增长而增加，尤其是对于女童。家庭中女性教育水平的提高减少了女童营养不良的不利因素。研究的局限性包括观测数据和缺失数据，这限制了我们得出强有力的因果推论的能力。在这项研究中，我们发现早期儿童营养不良与青春期前的身体和认知结果有关，特别是在女童中。女性教育水平的提高缓解了这种关联。促进女性教育应在印度公共卫生政策制定中发挥核心作用。Apurv Soni及其同事在印度研究儿童营养和发育结果。印度5岁以下营养不良儿童人数最多。先前的研究报告称，印度儿童营养不良中没有性别差异，尽管成年期存在有据可查的差异。目前解决儿童营养不良问题的国家方案侧重于生命的前5年，不包括注重性别的干预措施。我们进行了一项基于人群的队列研究，该研究基于2004年至2005年对印度41，554户家庭进行的全国代表性调查以及2011年至2012年对83%相同家庭的随访数据。这项研究利用印度唯一的全国代表性小组数据集报告说，生命前5年的营养不良与不良身体结果的几率增加有关，即，身材矮小，非常瘦，在青春期前不能阅读和做算术。营养不良的女童最容易遭受这些不利后果，在青春期前，性别差距随着年龄的增长而扩大。例如，营养不良女童身材矮小的调整概率从8奥尔兹的31%增加到11奥尔兹的45%。在男童中没有观察到这种增加。家庭中有一名受过中学以上教育的妇女，可以减轻营养不良和女童的不利条件。身体和认知结果的性别差异出现在青春期前，并与幼儿营养有关。家庭中女性教育水平较高是造成这些差异的重要保护因素。通过改善女性教育来提高妇女地位应成为印度国家一级以妇幼保健为重点的方案的核心。
There is a lack of nationally representative estimates for the consequences of early childhood undernutrition on preadolescent outcomes in India. Understanding this relationship is helpful to develop interventions that not only prevent child undernutrition but also mitigate its consequences. In this cohort study, we analyzed prospectively gathered data from 2 waves of the India Human Development Survey (IHDS) to investigate the association of undernutrition during early childhood (0 to 5 years) in 2004 to 2005 with physical and cognitive outcomes during preadolescent (8 to 11 years) years in 2011 to 2012. These surveys interviewed 41,554 households across all 33 states and union territories in India in 2004 to 2005 and reinterviewed 83% of the households in 2011 to 2012. Primary exposure was assessed using the Composite Index of Anthropometric Failure (CIAF) based on 2004 to 2005 survey. Primary outcomes were short stature (height-for-age z-score [HAZ] <−2), thinness (body mass index [BMI] <18.5 kg/m2), reading, and arithmetic skills during preadolescence based on the 2011 to 2012 survey. Survey-weighted generalized linear models were used, and effect modification based on child sex and sociodemographic variables were evaluated using 3-way interaction terms. Of the 7,868 children included in this analysis, 4,334 (57.3%) were undernourished. Being undernourished was associated with increased odds of short stature (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.45 to 2.06) and thinness (OR 1.52, 95% CI 1.33 to 1.73) during the preadolescent period, while it was associated with decreased odds of achieving a higher reading (cumulative odds ratio [cumOR]: 0.76, 0.66 to 0.87) and arithmetic (cumOR: 0.72, 0.63 to 0.82) outcomes. The disparity in outcomes based on CIAF increased with age, especially for female children. Increased level of female education within the household reduced the disadvantages of undernutrition among female children. Study limitations include observational and missing data, which limit our ability to draw strong causal inferences. In this study, we found that early child undernutrition was associated with several adverse preadolescent physical and cognitive outcomes, especially among female children. Improved female education mitigates this association. Female education promotion should assume a central role in Indian public health policy making. Apurv Soni and co-workers study child nutrition and developmental outcomes in India. India has the largest number of undernourished children under the age of 5. Previous studies report an absence of gender disparities among child undernutrition in India despite well-documented disparities in adulthood. Current national programs for addressing child undernutrition focus on the first 5 years of life and do not include gender-focused interventions. We carried out a population-based cohort study based on data gathered prospectively from nationally representative survey of 41,554 households in India in 2004 to 2005 and a follow-up in 2011 to 2012 among 83% of the same households. This study leverages India’s only nationally representative panel dataset to report that undernutrition in the first 5 years of life is associated with increased odds of adverse physical outcomes, i.e., having short stature and being very thin and cognitive outcomes, i.e., unable to read and do arithmetic during preadolescent years. Female children who were undernourished were the most vulnerable for experiencing these adverse outcomes, and the gender disparities widened with age during the preadolescent period. As an example, the adjusted probability of short stature for undernourished female children increased from 31% among 8 year olds to 45% among 11 year olds. There was no such increase observed among male children. Presence of a woman in the household with more than secondary level of education mitigated the disadvantage associated with both being undernourished and being a female child. Sex differences in physical and cognitive outcomes emerge during the preadolescent period and are associated with early childhood nutrition. Higher level of female education within the household is an important protective factor for these disparities. Elevation of women’s status through improved female education should be central to the national level programs in India focused on maternal and child health.