Harvard Center for Population & Development Studies, Cambridge, MA, USA.
Nutrition, Tata Trusts, India.
Soc Sci Med. 2019 Oct;238:112374. doi: 10.1016/j.socscimed.2019.112374. Epub 2019 Jun 20.
Despite the broad consensus that investments in nutrition-sensitive programmes are required to reduce child undernutrition, in practice empirical studies and interventions tend to focus on few nutrition-specific risk factors in isolation. The 2015-16 National Family Health Survey provides the first opportunity in more than a decade to conduct an up-to-date comprehensive evaluation of the relative importance of various maternal and child health and nutrition (MCHN) factors in respect to child anthropometric failures in India. The primary analysis included 140,444 children aged 6-59 months with complete data on 20 MCHN factors, and the secondary analysis included a subset of 25,603 children with additional paternal data. Outcome variables were stunting, underweight and wasting. We conducted logistic regression models to first evaluate each correlate separately in age- and sex-adjusted models, and then jointly in a mutually adjusted model. For all anthropometric failures, indicators of past and present socioeconomic conditions showed the most robust associations. The strongest correlates for stunting were short maternal stature (OR: 4.39; 95%CI: 4.00, 4.81), lack of maternal education (OR: 1.74; 95%CI: 1.60, 1.89), low maternal BMI (OR: 1.64; 95%CI: 1.54, 1.75), poor household wealth (OR: 1.25; 95%CI: 1.15, 1.35) and poor household air quality (OR: 1.22; 95%CI: 1.16, 1.29). Weaker associations were found for other correlates, including dietary diversity, vitamin A supplementation and breastfeeding initiation. Paternal factors were also important predictors of anthropometric failures, but to a lesser degree than maternal factors. The results remained consistent when stratified by children's age (6-23 vs 24-59 months) and sex (girls vs boys), and when low birth weight was additionally considered. Our findings indicate the limitation of nutrition-specific interventions. Breaking multi-generational poverty and improving environmental factors are promising investments to prevent anthropometric failures in early childhood.
尽管人们普遍认为需要投资于对营养敏感的方案，以减少儿童营养不良，但实际上，经验性研究和干预往往侧重于孤立的少数营养特定风险因素。2015-16 年全国家庭健康调查提供了十多年来首次对印度各种母婴健康和营养（MCHN）因素相对于儿童体格发育失败的相对重要性进行最新全面评估的机会。主要分析包括 140444 名 6-59 个月大的儿童，他们有 20 项母婴健康和营养因素的完整数据，次要分析包括 25603 名儿童的一个子集，他们有额外的父亲数据。结果变量是发育迟缓、体重不足和消瘦。我们进行了逻辑回归模型分析，首先在年龄和性别调整模型中单独评估每个相关因素，然后在相互调整的模型中联合评估。对于所有体格发育失败，过去和现在的社会经济条件指标显示出最强大的关联。发育迟缓的最强相关因素是母亲身材矮小（OR：4.39；95%CI：4.00，4.81）、母亲缺乏教育（OR：1.74；95%CI：1.60，1.89）、母亲 BMI 低（OR：1.64；95%CI：1.54，1.75）、家庭贫困（OR：1.25；95%CI：1.15，1.35）和家庭空气质量差（OR：1.22；95%CI：1.16，1.29）。其他相关因素的关联较弱，包括饮食多样性、维生素 A 补充和母乳喂养开始。父亲因素也是体格发育失败的重要预测因素，但程度低于母亲因素。当按儿童年龄（6-23 个月与 24-59 个月）和性别（女孩与男孩）分层，以及当额外考虑低出生体重时，结果仍然一致。我们的研究结果表明，营养特定干预措施存在局限性。打破代际贫困和改善环境因素是预防儿童早期体格发育失败的有前途的投资。
