Early childhood undernutrition, preadolescent physical growth, and cognitive achievement in India: A population-based cohort study

Yount, Kathryn Mary and Soni, Apurv and Fahey, Nisha and Bhutta, Zulfiqar A. and Li, Wenjun and Frazier, Jean A. and Moore Simas, Tiffany and Nimbalkar, Somashekhar M. and Allison, Jeroan J. (2021) Early childhood undernutrition, preadolescent physical growth, and cognitive achievement in India: A population-based cohort study. PLOS Medicine, 18 (10). e1003838. ISSN 1549-1676

[thumbnail of journal.pmed.1003838.pdf] Text
journal.pmed.1003838.pdf - Published Version

Download (1MB)

Abstract

Background
There is a lack of nationally representative estimates for the consequences of early childhood undernutrition on preadolescent outcomes in India. Understanding this relationship is helpful to develop interventions that not only prevent child undernutrition but also mitigate its consequences.

Methods and findings
In this cohort study, we analyzed prospectively gathered data from 2 waves of the India Human Development Survey (IHDS) to investigate the association of undernutrition during early childhood (0 to 5 years) in 2004 to 2005 with physical and cognitive outcomes during preadolescent (8 to 11 years) years in 2011 to 2012. These surveys interviewed 41,554 households across all 33 states and union territories in India in 2004 to 2005 and reinterviewed 83% of the households in 2011 to 2012. Primary exposure was assessed using the Composite Index of Anthropometric Failure (CIAF) based on 2004 to 2005 survey. Primary outcomes were short stature (height-for-age z-score [HAZ] <−2), thinness (body mass index [BMI] <18.5 kg/m2), reading, and arithmetic skills during preadolescence based on the 2011 to 2012 survey. Survey-weighted generalized linear models were used, and effect modification based on child sex and sociodemographic variables were evaluated using 3-way interaction terms. Of the 7,868 children included in this analysis, 4,334 (57.3%) were undernourished. Being undernourished was associated with increased odds of short stature (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.45 to 2.06) and thinness (OR 1.52, 95% CI 1.33 to 1.73) during the preadolescent period, while it was associated with decreased odds of achieving a higher reading (cumulative odds ratio [cumOR]: 0.76, 0.66 to 0.87) and arithmetic (cumOR: 0.72, 0.63 to 0.82) outcomes. The disparity in outcomes based on CIAF increased with age, especially for female children. Increased level of female education within the household reduced the disadvantages of undernutrition among female children. Study limitations include observational and missing data, which limit our ability to draw strong causal inferences.

Conclusions
In this study, we found that early child undernutrition was associated with several adverse preadolescent physical and cognitive outcomes, especially among female children. Improved female education mitigates this association. Female education promotion should assume a central role in Indian public health policy making.

Item Type: Article
Subjects: Universal Eprints > Medical Science
Depositing User: Managing Editor
Date Deposited: 18 Nov 2022 04:16
Last Modified: 22 Sep 2023 08:03
URI: http://journal.article2publish.com/id/eprint/276

Actions (login required)

View Item
View Item