Division of Epidemiology, Biostatistics, and Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India.
Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India.
BMC Public Health. 2024 Jan 5;24(1):96. doi: 10.1186/s12889-023-17520-8.
Prevalence of undernutrition continues to be high in India and low household wealth is consistently associated with undernutrition. This association could be modified through improved dietary intake, including dairy consumption in young children. The beneficial effect of dairy on child growth has not been explored at a national level in India. The present analyses aimed to evaluate the direct and indirect (modifying association of household level per adult female equivalent milk and milk product consumption) associations between household wealth index on height for age (HAZ) and weight for age (WAZ) in 6-59 months old Indian children using data from of nationally representative surveys.
Two triangulated datasets of two rounds of National Family Health Survey, (NFHS-3 and 4) and food expenditure (National Sample Survey, NSS61 and 68) surveys, were produced by statistical matching of households using Non-Iterative Bayesian Approach to Statistical Matching technique. A Directed Acyclic Graph was constructed to map the pathways in the relationship of household wealth with HAZ and WAZ based on literature. The direct association of wealth index and its indirect association through per adult female equivalent dairy consumption on HAZ and WAZ were estimated using separate path models for each round of the surveys.
Wealth index was directly associated with HAZ and WAZ in both the rounds, but the association decreased from NFHS-3 (β: 0.145; 95% CI: 0.129, 0.16) to NFHS-4 (β: 0.102; 95%CI: 0.093, 0.11). Adult female equivalent milk intake (increase of 10gm/day) was associated with higher HAZ (β_NFHS-3=0.001;95% CI: 0, 0.002; β_NFHS-4=0.002;95% CI: 0.002, 0.003) but had no association with WAZ. The indirect association of wealth with HAZ through dairy consumption was 2-fold higher in NFHS-4 compared to NFHS-3.
The analysis of triangulated survey data shows that household level per- adult female equivalent dairy consumption positively modified the association between wealth index and HAZ, suggesting that regular inclusion of milk and milk products in the diets of children from households across all wealth quintiles could improve linear growth in this population.
在印度，营养不良的患病率仍然很高，而家庭贫困与营养不良之间始终存在关联。通过改善饮食摄入（包括儿童摄入乳制品），这种关联可以得到改善。在印度，还没有在全国范围内探讨乳制品对儿童生长的有益影响。本分析旨在使用全国代表性调查的数据，评估家庭财富指数与 6-59 个月龄印度儿童身高年龄别（HAZ）和体重年龄别（WAZ）之间的直接和间接（通过家庭中每个成年女性当量的牛奶和奶制品消费来调节关联）关联。
通过使用非迭代贝叶斯统计匹配技术对家庭进行统计匹配，生成两轮全国家庭健康调查（NFHS-3 和 4）和食物支出调查（全国样本调查，NSS-61 和 68）的两个三角数据集。根据文献构建有向无环图，以映射家庭财富与 HAZ 和 WAZ 之间关系的途径。使用每个调查轮次的单独路径模型来估计财富指数与 HAZ 和 WAZ 的直接关联及其通过每个成年女性当量乳制品消费的间接关联。
在两轮调查中，财富指数与 HAZ 和 WAZ 均存在直接关联，但从 NFHS-3（β：0.145；95%CI：0.129，0.16）到 NFHS-4（β：0.102；95%CI：0.093，0.11），这种关联有所下降。成年女性当量牛奶摄入量（每天增加 10 克）与较高的 HAZ 相关（NFHS-3：β=0.001；95%CI：0，0.002；NFHS-4：β=0.002；95%CI：0.002，0.003），但与 WAZ 无关。通过乳制品消费，财富与 HAZ 之间的间接关联在 NFHS-4 中是 NFHS-3 的两倍。
三角调查数据的分析表明，家庭层面每个成年女性当量的乳制品消费对财富指数与 HAZ 之间的关联具有积极的调节作用，这表明在所有财富五分位数的家庭中定期将牛奶和奶制品纳入儿童饮食，可能会改善该人群的线性生长。
