Tata Centre for Development, University of Chicago, Chicago, IL.
Center for Disease Dynamics, Economics, and Policy, Washington, DC.
J Nutr. 2018 Jan 1;148(1):140-146. doi: 10.1093/jn/nxx012.
India's Integrated Child Development Services (ICDS) is among the world's largest public nutritional programs, providing daily nutritional supplements and other public health and educational services to pregnant and nursing women, children aged <6 y, and adolescent girls.
We estimated the long-term association between early-childhood ICDS nutrition and adult outcomes.
We used follow-up data from a controlled nutritional trial conducted during 1987-1990 in 29 villages near the city of Hyderabad. In 15 intervention villages, a balanced protein-calorie supplement-made from locally available corn-soya ingredients and called upma-was offered to pregnant women and to children <6 y old. No supplement was offered in the 14 control villages. During 2010-2012, adults born during the trial were re-surveyed (n = 715 in the intervention arm and n = 645 in the control arm). We used probit regression and propensity score-matching methods to estimate the association between birth in an intervention village and rates of secondary and graduate education completion, marriage, and employment or enrollment in higher education of these adults.
Adults born in the intervention group during the trial, compared with the control group, were 9% (95% CI: 0.04, 0.14; P < 0.01) more likely to complete secondary school and 11% (95% CI: 0.06, 0.15; P < 0.01) more likely to complete graduate education, were 6% (95% CI: -0.11, -0.01; P < 0.05) less likely to be ever-married at age 20-25 y, and were 5% (95% CI: 0, 0.11; P < 0.05) more likely to be employed or enrolled in higher education. The estimated associations for graduate education completion and employment-study rates were greater for men, whereas the associations for secondary education and ever-married rates were greater for women.
Exposure to nutritional supplement in utero or during the first 3 y of life was associated with improved adult educational and employment outcomes and lower marriage rates in India.
印度的综合儿童发展服务（ICDS）是世界上最大的公共营养计划之一，为孕妇和哺乳期妇女、6 岁以下儿童和青春期女孩提供每日营养补充以及其他公共卫生和教育服务。
我们评估了儿童早期 ICDS 营养与成人结局之间的长期关联。
我们使用了 1987-1990 年在海得拉巴市附近 29 个村庄进行的一项对照营养试验的随访数据。在 15 个干预村庄中，向孕妇和 6 岁以下儿童提供了一种由当地可用的玉米-大豆成分制成的均衡蛋白质-卡路里补充剂，称为 upma。在 14 个对照村庄不提供补充剂。2010-2012 年，对试验期间出生的成年人进行了重新调查（干预组 715 人，对照组 645 人）。我们使用概率回归和倾向评分匹配方法来估计出生在干预村庄与这些成年人接受中等和高等教育完成率、婚姻以及就业或接受高等教育的关联。
与对照组相比，在试验中出生于干预组的成年人完成中学教育的可能性高 9%（95%CI：0.04，0.14；P<0.01），完成高等教育的可能性高 11%（95%CI：0.06，0.15；P<0.01），20-25 岁时已婚的可能性低 6%（95%CI：-0.11，-0.01；P<0.05），就业或接受高等教育的可能性高 5%（95%CI：0，0.11；P<0.05）。对于男性，完成高等教育和就业-学习率的关联估计更高，而对于女性，中学教育和已婚率的关联更高。
在子宫内或生命的头 3 年接触营养补充剂与印度成年人教育和就业结果的改善以及较低的结婚率有关。
