Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, United States; Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, United States.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Soc Sci Med. 2017 Nov;193:101-109. doi: 10.1016/j.socscimed.2017.09.039. Epub 2017 Sep 22.
Stunting, caused by experiences of chronic nutritional deprivation, affects approximately 25% of children under age five globally (i.e., 156 million children). In this review, evidence of a relationship between stunting and child development in low- and middle-income countries is summarized, and issues for further research are discussed. We focus on studies that measured low height-for-age among children less than 5 years old as the exposure and gross/fine motor skills, psychosocial competencies, cognitive abilities, or schooling and learning milestones as the outcomes. This review highlights three key findings. First, the variability in child development tools and metrics used among studies and the differences in the timing and frequency of the assessments complicate comparisons across study findings. Second, considerable evidence from across many countries supports an association between stunting and poor child development despite methodological differences and heterogeneity in the magnitude of associations. Further, effect sizes differ by developmental domain with greater associations shown for cognitive/schooling outcomes. How stunting influences child development, which domains of child development are more affected, and how the various domains of child development influence one another require further experimental research to test causal pathways. Finally, there is mixed evidence of the additive effect of nutrition + stimulation interventions on child development. However, understanding best methods for improving child developmental outcomes - either through nutrition programs or through integrated nutrition + psychosocial stimulation programs (or nutrition + other program interventions) - is a key area of further inquiry. Given that nearly 40% of children under age five suffer from loss of developmental potential - for which stunting is likely one of the key risk factors - reductions in stunting could have tremendous implications for child development and human capital formation, particularly in low- and middle-income countries.
发育迟缓是由长期营养缺乏引起的,全球约有 25%的五岁以下儿童受到影响(即 1.56 亿儿童)。在这篇综述中,总结了发育迟缓与中低收入国家儿童发育之间关系的证据,并讨论了进一步研究的问题。我们重点关注那些以身高低于年龄为暴露因素,以粗大/精细运动技能、心理社会能力、认知能力或学校教育和学习里程碑为结局的研究。这篇综述强调了三个关键发现。首先,研究中使用的儿童发育工具和指标的变异性以及评估的时间和频率的差异,使得研究结果之间的比较变得复杂。其次,尽管方法学上存在差异,而且关联的幅度存在异质性,但来自许多国家的大量证据支持发育迟缓与儿童发育不良之间存在关联。此外,效应大小因发育领域而异,认知/学校教育结果的关联更大。发育迟缓如何影响儿童发育、儿童发育的哪些领域受影响更大以及儿童发育的各个领域如何相互影响,需要进一步的实验研究来检验因果关系。最后,营养+刺激干预对儿童发育的附加效应的证据不一。然而,了解改善儿童发育结果的最佳方法——无论是通过营养计划还是通过综合营养+心理社会刺激计划(或营养+其他计划干预)——是进一步研究的关键领域。由于近 40%的五岁以下儿童丧失了发展潜力——发育迟缓可能是其中一个关键风险因素——因此减少发育迟缓对儿童发育和人力资本形成具有巨大意义,尤其是在中低收入国家。