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

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 = 0.31 ± 0.05] and mental development scores [(β coefficient ± SE) in children 6-11 mo: LAZ = 0.57 ± 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. This trial was registered at clinicaltrials.gov as NCT02593136.

Keywords: child development; dietary diversity; malnutrition; mental; motor; nutrition.

FIGURE 1

Mediation analysis between dietary diversity and mental development in children 6–11 mo of age. Values are unstandardized coefficients. Covariates include age, household wealth, maternal education, paternal education, recent morbidity, caste, and food deprivation. All models account for cluster randomization by health subcenter. Weight-for-length z score, household stimulation, and anemia were not examined as potential mediators in children 6–11 mo of age because they were not significantly associated with dietary diversity or the outcome. Solid arrows represent the associations for each mediator separately. Associations between dietary diversity and mediators are adjusted for covariates, and associations between mediators and mental development are adjusted for dietary diversity and covariates. Dashed arrow represents association adjusting for covariates. *P < 0.05, ***P < 0.001. ^†Significant mediator with the use of Sobel’s test. LAZ, length-for-age z score,.

FIGURE 2

Mediation analysis between dietary diversity and mental development in children 12–18 mo of age. Values are unstandardized coefficients. Covariates include age, household wealth, maternal education, paternal education, recent morbidity, caste, and food deprivation. All models account for cluster randomization by health subcenter. Weight-for-length z score, length-for-age z score, and anemia were not examined as potential mediators in children 12–18 mo of age because they were not significantly associated with dietary diversity or the outcome. Solid arrows represent associations for each mediator separately. Associations between dietary diversity and mediators are adjusted for covariates; and associations between mediators and mental development are adjusted for dietary diversity and covariates. Dashed arrow represents association adjusting for covariates. **P < 0.01, ***P < 0.001. ^†Significant mediator with the use of Sobel’s test.