Larson Leila M, Young Melissa F, Ramakrishnan Usha, Webb Girard Amy, Verma Pankaj, Chaudhuri Indrajit, Srikantiah Sridhar, Martorell Reynaldo
Nutrition and Health Sciences Program, Laney Graduate School and
Nutrition and Health Sciences Program, Laney Graduate School and.
J Nutr. 2017 Aug;147(8):1578-1585. doi: 10.3945/jn.117.251231. Epub 2017 Jun 14.
Many malnourished children in resource-poor settings fail to fulfill their developmental potential. The objectives of this analysis were to examine the nutritional, psychosocial, environmental, and household correlates of child development in Bihar, India, and identify mediators between dietary diversity and mental development. Using 2-stage cluster randomized sampling, we surveyed 4360 households with children 6-18 mo of age in the West Champaran district of Bihar. We measured motor and mental development with the use of the Developmental Milestones Checklist II. In a random subsample ( = 2838), we measured anthropometric characteristics and hemoglobin. Cluster-adjusted multiple linear regression analysis was used to examine the associations between nutrition indicators and development scores. Sobel's test was used to assess significant mediators in the association between diet diversity and development scores. Analyses were stratified by children 6-11 and 12-18 mo of age. In all children, length-for-age score (LAZ), dietary diversity, and psychosocial stimulation were significant ( < 0.05) correlates of motor development scores [(β coefficient ± SE) in children 6-11 mo: LAZ = 0.46 ± 0.08, dietary diversity = 0.43 ± 0.09, and stimulation = 0.15 ± 0.04; in children 12-18 mo: LAZ = 0.73 ± 0.07, dietary diversity = 0.30 ± 0.09, and stimulation = 0.31 ± 0.05] and mental development scores [(β coefficient ± SE) in children 6-11 mo: LAZ = 0.57 ± 0.10, dietary diversity = 0.84 ± 0.13, and stimulation = 0.54 ± 0.07; in children 12-18 mo: LAZ = 0.54 ± 0.11, dietary diversity = 0.40 ± 0.16, and stimulation = 0.62 ± 0.09]. Stimulation, gross motor development, and fine motor development were significant mediators in the relation between dietary diversity and mental development. Strategies to improve dietary diversity and psychosocial stimulation could have important implications for child development of young North Indian children. This trial was registered at clinicaltrials.gov as NCT02593136.
在资源匮乏地区，许多营养不良的儿童无法充分发挥其发育潜力。本分析的目的是研究印度比哈尔邦儿童发育的营养、心理社会、环境和家庭相关因素，并确定饮食多样性与智力发育之间的中介因素。我们采用两阶段整群随机抽样方法，对比哈尔邦西昌帕兰区4360户有6至18个月大儿童的家庭进行了调查。我们使用《发育里程碑检查表II》来测量运动和智力发育情况。在一个随机子样本（n = 2838）中，我们测量了人体测量特征和血红蛋白。采用整群调整的多元线性回归分析来研究营养指标与发育得分之间的关联。使用索贝尔检验来评估饮食多样性与发育得分之间关联中的显著中介因素。分析按6至11个月和12至18个月大的儿童分层。在所有儿童中，年龄别身长（LAZ）得分、饮食多样性和心理社会刺激是运动发育得分的显著（P < 0.05）相关因素[6至11个月大儿童的（β系数±标准误）：LAZ = 0.46 ± 0.08，饮食多样性 = 0.43 ± 0.09，刺激 = 0.15 ± 0.04；12至18个月大儿童的：LAZ = 0.73 ± 0.07，饮食多样性 = 0.30 ± 0.09，刺激 = 0.31 ± 0.05]以及智力发育得分的显著（P < 0.05）相关因素[6至11个月大儿童的（β系数±标准误）：LAZ = 0.57 ± 0.10，饮食多样性 = 0.84 ± 0.13，刺激 = 0.54 ± 0.07；12至18个月大儿童的：LAZ = 0.54 ± 0.11，饮食多样性 = 0.40 ± 0.16，刺激 = 0.62 ± 0.09]。刺激、大运动发育和精细运动发育是饮食多样性与智力发育之间关系的显著中介因素。改善饮食多样性和心理社会刺激的策略可能对印度北部幼儿的发育具有重要意义。本试验已在ClinicalTrials.gov上注册，注册号为NCT02593136。
