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Author Notes:

Address correspondence to LML (e-mail: leila.larson@emory.edu).

The authors’ responsibilities were as follows—LML: designed the child development component of the study, supervised the data collection, analyzed the data, and drafted the initial manuscript; MFY, UR, AWG, PV, IC, SS, and RM: contributed to the design of the study, supervised the data collection, and critically reviewed the manuscript; SS and RM: secured funding for the study; and all authors: read and approved the final manuscript.

We thank Rukshan Mehta and Priya Kekre for their contribution to the coordination of the study and data collection. We also thank our collaborators at CARE India for their support in the design and implementation of the study.

Author disclosures: LML, MFY, UR, AWG, PV, IC, SS, and RM, no conflicts of interest.


Research Funding:

Supported by a Bill & Melinda Gates Foundation grant through a subcontract with CARE India.

LML received PhD funding from the Laney Graduate School, Emory University.


  • 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

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


Journal Title:

Journal of Nutrition and Food Sciences


Volume 147, Number 8


, Pages 1578-1585

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2017 American Society for Nutrition

This is an Open Access work distributed under the terms of the Creative Commons Attribution 3.0 IGO License License (https://creativecommons.org/licenses/by/3.0/igo/).
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