Mbabazi Joseph, Pesu Hannah, Mutumba Rolland, McCray Gareth, Ritz Christian, Filteau Suzanne, Briend André, Mupere Ezekiel, Grenov Benedikte, Friis Henrik, Olsen Mette F
Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.
PLOS Glob Public Health. 2024 Aug 15;4(8):e0003456. doi: 10.1371/journal.pgph.0003456. eCollection 2024.
Millions of children under 5 years in low- and middle-income countries fail to attain their development potential with accruing short- and long-term consequences. Low length/height for age (stunting) is known to be a key factor, but there is little data on how child characteristics are linked with developmental changes among children with stunting. We assessed the socioeconomic, household, anthropometric, and clinical predictors of change in early child development (ECD) among 1-5-year-old children with stunting. This was a prospective cohort study nested in a randomized trial testing effects of lipid-based nutrient supplementation among children with stunting in Uganda. Development was assessed using the Malawi Development Assessment Tool (MDAT). Multiple linear regression analysis was used to assess for predictors of change. We included 750 children with mean ±SD age of 30.2 ±11.7 months 45% of whom were female. After 12 weeks, total MDAT z-score increased by 0.40 (95%CI: 0.32; 0.48). Moderate vs severe stunting, higher fat-free mass, negative malaria test and no inflammation (serum α-1-acid glycoprotein <1 g/l) at baseline predicted greater increase in ECD scores. Older age and fat mass gain predicted a lesser increase in ECD. Our findings reinforce the link between stunting and development with more severely stunted children having a lesser increase in ECD scores over time. Younger age, freedom from malaria and inflammation, and higher fat-free mass at baseline, as well as less gain of fat mass during follow-up predicted a higher increase in developmental scores in this study. Thus, supporting fat-free mass accretion, focusing on younger children, and infection prevention may improve development among children with stunting.
在低收入和中等收入国家，数以百万计的5岁以下儿童未能发挥其发展潜力，从而产生了短期和长期后果。年龄别身长/身高偏低（发育迟缓）是一个关键因素，但关于发育迟缓儿童的个体特征与发育变化之间的联系的数据很少。我们评估了1-5岁发育迟缓儿童早期儿童发育（ECD）变化的社会经济、家庭、人体测量和临床预测因素。这是一项前瞻性队列研究，嵌套在一项随机试验中，该试验测试了乌干达发育迟缓儿童基于脂质的营养补充剂的效果。使用马拉维发育评估工具（MDAT）评估发育情况。采用多元线性回归分析来评估预测因素。我们纳入了750名儿童，平均年龄±标准差为30.2±11.7个月，其中45%为女性。12周后，MDAT总z评分增加了0.40（95%CI：0.32；0.48）。基线时中度与重度发育迟缓、较高的去脂体重、疟疾检测阴性和无炎症（血清α-1-酸性糖蛋白<1 g/l）预测ECD评分有更大增加。年龄较大和脂肪量增加预测ECD增加较少。我们的研究结果强化了发育迟缓与发育之间的联系，发育迟缓更严重的儿童随着时间推移ECD评分增加较少。在本研究中，年龄较小、无疟疾和炎症、基线时去脂体重较高以及随访期间脂肪量增加较少预测发育评分有更高增加。因此，支持去脂体重增加、关注幼儿以及预防感染可能会改善发育迟缓儿童的发育情况。
