Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.
RTI International, Research Triangle Park, NC.
Dev Sci. 2019 Sep;22(5):e12806. doi: 10.1111/desc.12806. Epub 2019 Mar 18.
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.
发育迟缓与儿童的发展呈负相关。我们通过检验以下假设来研究身高的范围：（a）身高与儿童的发展呈正相关，其关联受炎症的调节；（b）以关爱和早期学习机会为特征的家庭环境与儿童的发展呈正相关，并随着时间的推移减弱与身高的关联。数据来自印度农村一项多种微量营养素粉（MNPs）的随机对照试验，包括 513 名婴儿（平均年龄 8.6 个月）和 316 名学龄前儿童（平均年龄 36.6 个月）。测量包括身高（根据世卫组织标准的身高年龄 z 分数）、炎症（C 反应蛋白浓度＞5mg/L）、关爱（HOME 量表）、儿童发展（Mullens 早期学习量表）和抑制控制（学龄前儿童）。线性混合效应模型考虑了重复测量、聚类和混杂因素，用于评估身高与儿童发展随时间的关联（婴儿：入组、6 个月和 12 个月；学龄前儿童：入组和 8 个月）。采用交互项检验炎症和关爱对身高与儿童发展之间关联的调节作用。在婴儿和学龄前儿童中，身高和关爱与儿童发展的所有领域均呈正相关，除了抑制控制。在学龄前儿童中，存在炎症时，身高与儿童发展无关。在婴儿中，而不是学龄前儿童中，关爱型家庭环境减弱了身高与精细运动和接受性语言发展之间的显著关联。与儿童随时间发展相关的机制是多因素的，包括营养、健康和家庭环境之间的直接和间接关联，这得到了关爱护理框架的支持。
