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. 2019 Sep;22(5):e12806.
doi: 10.1111/desc.12806. Epub 2019 Mar 18.

Mechanisms linking height to early child development among infants and preschoolers in rural India

Maureen M Black  1   2 , Doris P Yimgang  3 , Kristen M Hurley  4 , Kimberly B Harding  5 , Sylvia Fernandez-Rao  6 , Nagalla Balakrishna  6 , Kankipati V Radhakrishna  6 , Gregory A Reinhart  7 , Krishnapillai Madhavan Nair  6
Affiliations

Mechanisms linking height to early child development among infants and preschoolers in rural India

Maureen M Black et al. Dev Sci. 2019 Sep.

Abstract

Stunting has been negatively associated with children's development. We examined the range of height by testing hypotheses: (a) height is positively associated with children's development, with associations moderated by inflammation and (b) home environments characterized by nurturance and early learning opportunities is positively associated with children's development over time and attenuate associations with height. Data included 513 infants (mean age 8.6 months) and 316 preschoolers (mean age 36.6 months) in rural India from a randomized controlled trial of multiple micronutrient powders (MNPs). Measures included height (height-for-age z-scores based on WHO standards), inflammation (C-reactive protein concentration >5 mg/L), nurturance (HOME Inventory), child development (Mullens Scales of Early Learning), and inhibitory control (preschoolers). Linear mixed effects models accounting for repeated measures, clustering, and confounders were used to assess associations between height and child development over time (infants: enrollment, 6 and 12 months; preschoolers: enrollment and 8 months). Moderating effects of inflammation and nurturance were tested with interaction terms. Among infants and preschoolers, height and nurturance were positively associated with all domains of child development over time, with the exception of inhibitory control. Among preschoolers, in the presence of inflammation, height was not associated with child development. Among infants, but not preschoolers, a nurturant home environment attenuated significant associations between height with fine motor and receptive language development. The mechanisms associated with children's development over time are multifactorial and include direct and indirect associations among nutrition, health, and the home environment, as supported by the Nurturing Care Framework.

Keywords: HOME; 1,000 days; child development; global; height; infant development; inflammation; preschool development; stunting.

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Conflict of interest statement

Conflict of Interest: None of the authors has a conflict of interest. Kimberly Harding is an employee of Nutrition International (formerly Micronutrient Initiative) and Gregory Reinhart was formerly an employee of The Mathile Institute for the Advancement of Human Nutrition.

Figures

Figure 1.
Figure 1.. Child developmental scores over time.
1a. Infants: enrollment through 6- and 12-months. 1b. Preschoolers: enrollment through 8-months.
Figure 2.
Figure 2.. Adjusted mean change in child development by HAZ, moderated by inflammation (CRP>5) among preschoolers.
2a. Visual reception. 2b. Fine Motor. 2c. Receptive language.
Figure 2.
Figure 2.. Adjusted mean change in child development by HAZ, moderated by inflammation (CRP>5) among preschoolers.
2a. Visual reception. 2b. Fine Motor. 2c. Receptive language.
Figure 2.
Figure 2.. Adjusted mean change in child development by HAZ, moderated by inflammation (CRP>5) among preschoolers.
2a. Visual reception. 2b. Fine Motor. 2c. Receptive language.
Figure 3.
Figure 3.. Adjusted mean change in child development by HAZ, moderated by nurturance among infants.
3a. Fine Motor. 3b. Receptive language.
Figure 3.
Figure 3.. Adjusted mean change in child development by HAZ, moderated by nurturance among infants.
3a. Fine Motor. 3b. Receptive language.
See this image and copyright information in PMC

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