Department of Pediatrics, Tufts Medical Center and Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
Nutrition Diet and Health, Division of Poverty, Health, and Nutrition, International Food Policy Research Institute, Kathmandu, Nepal.
Matern Child Nutr. 2024 Jul;20(3):e13637. doi: 10.1111/mcn.13637. Epub 2024 Mar 15.
Poor diet quality (diet diversity and animal-source food [ASF] consumption) during childhood negatively affects growth, development, behaviour and physiologic function in later life. Relatively less is known about the impact of poor diet on the growth of school-age children compared to children <5 years of age, especially in low/middle-income countries. A better understanding of delivery strategies for effective interventions to improve diet and hence growth in school-age children is needed. A 36-month longitudinal controlled impact evaluation in rural Nepal assessed the nutrition and growth of children <5 years of age in families assigned via community clusters to full package intervention (community development, training in nutrition [during pregnancy and for children <5 years] and livestock husbandry), partial package (training only) or control (no inputs). Concurrent data were collected prospectively (baseline plus additional four rounds) on school-age children (5-8 years at baseline) in these households; the present study analysed findings in the cohort of school-age children seen at all five study visits (n = 341). Diet quality improved more in the full package school-age children compared to those in partial package or control households. full package children consumed more ASF (β +0.40 [CI 0.07,0.73], p < 0.05), more diverse diets (β +0.93 [CI 0.55,1.31], p < 0.001) and had better head circumference z-scores (β +0.21 [CI 0.07,0.35], p < 0.01) than control children. In conclusion, a multi-sectoral community development intervention was associated with improvements in diet and growth of school-age children in rural Nepal even though the intervention focused on the diet of children <5 years of age. The diet and growth of school-age children can be favourably influenced by community-level interventions, even indirectly.
儿童时期较差的饮食质量（饮食多样性和动物源食品[ASF]的摄入）会对其以后的生长、发育、行为和生理功能产生负面影响。与 5 岁以下儿童相比，人们对较差的饮食对学龄儿童生长的影响相对了解较少，尤其是在中低收入国家。需要更好地了解有效的干预措施的实施策略，以改善学龄儿童的饮食和生长。在尼泊尔农村进行了一项为期 36 个月的纵向对照影响评估，评估了通过社区集群分配给全套餐干预（社区发展、孕妇和 5 岁以下儿童营养培训以及畜牧业）、部分套餐（仅培训）或对照组（无投入）的家庭中 5 岁以下儿童的营养和生长情况。同时在这些家庭中的学龄儿童（基线时为 5-8 岁）前瞻性收集了同期数据（基线加另外四轮）；本研究分析了在所有五次研究访问中均可见的学龄儿童队列中的发现（n=341）。与部分套餐或对照组家庭相比，全套餐的学龄儿童饮食质量改善更多。全套餐儿童摄入更多的 ASF（β+0.40 [CI 0.07,0.73]，p<0.05）、更多样化的饮食（β+0.93 [CI 0.55,1.31]，p<0.001），头围 Z 分数也更好（β+0.21 [CI 0.07,0.35]，p<0.01）。结论是，即使干预重点是 5 岁以下儿童的饮食，多部门社区发展干预措施与尼泊尔农村地区学龄儿童的饮食和生长改善有关。社区层面的干预措施甚至可以间接有利地影响学龄儿童的饮食和生长。
