A cross-sectional survey in rural Bihar, India, indicates that nutritional status, diet, and stimulation are associated with motor and mental development in young children

• Authors: Leila M. Larson, Emory University; Melissa Young, Emory University; Usha Ramakrishnan, Emory University; Amy Girard, Emory University; Pankaj Verma, CARE India; Indrajit Chaudhuri, CARE India; Sridhar Srikantiah, CARE India; Reynaldo Martorell, Emory University
• Journal Title: Journal of Nutrition and Food Sciences
• Volume: Volume 147, Number 8
• Publisher: OMICS International | 2017-08-01, Pages 1578-1585
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.3945/jn.117.251231
• Subjects: Health Sciences, Public Health
• Keywords: child development; dietary diversity; malnutrition; mental; motor; nutrition; Age Factors; Child Development; Cross-Sectional Studies; Diet; Feeding Behavior; Female; Humans; India; Infant; Infant Nutritional Physiological Phenomena; Male; Motor Skills; Nutritional Status; Psychosocial Deprivation; Social Environment; Surveys and Questionnaires

Abstract

Background: Many malnourished children in resource-poor settings fail to fulfill their developmental potential. Objective: The objectives of this analysis were to examine the nutritional, psychosocial, environmental, and household correlates of child development in Bihar, India, and identify mediators between dietary diversity and mental development. Methods: Using 2-stage cluster randomized sampling, we surveyed 4360 households with children 6-18 mo of age in the West Champaran district of Bihar. We measured motor and mental development with the use of the Developmental Milestones Checklist II. In a random subsample (n = 2838), we measured anthropometric characteristics and hemoglobin. Cluster-adjusted multiple linear regression analysis was used to examine the associations between nutrition indicators and development scores. Sobel's test was used to assess significant mediators in the association between diet diversity and development scores. Analyses were stratified by children 6-11 and 12-18 mo of age. Results: In all children, length-for-age z score (LAZ), dietary diversity, and psychosocial stimulation were significant (P < 0.05) correlates of motor development scores [(β coefficient ± SE) in children 6-11 mo: LAZ = 0.46 ± 0.08, dietary diversity = 0.43±0.09, and stimulation = 0.15±0.04; in children 12-18 mo: LAZ = 0.73±0.07, dietary diversity = 0.30±0.09, and stimulation = 0.316 0.05] and mental development scores [(b coefficient6 SE) in children 6-11 mo: LAZ = 0.576 0.10, dietary diversity = 0.84±0.13, and stimulation = 0.54±0.07; in children 12-18 mo: LAZ = 0.54±0.11, dietary diversity = 0.40±0.16, and stimulation = 0.62±0.09] . Stimulation, gross motor development, and fine motor development were significant mediators in the relation between dietary diversity and mental development. Conclusion: Strategies to improve dietary diversity and psychosocial stimulation could have important implications for child development of young North Indian children.