Association of Early Nutrition Deficit with Early Childhood Development in Children 36 to 59 Months within and across Populations in Low‐ and Middle‐Income Countries
Authors: Reyes Ligia I. , Frongillo Edward A. , Kulkarni Shibani , Basnet Sulochana , de Castro Filipa 
Published: November 2023

Despite improved child nutritional status over the past 20 years, many children do not reach their developmental potential in low‐ and middle‐income countries (LMIC). Inadequate nutrition, particularly during the first 1000 days of life, compromises early childhood development (ECD), which in turn poses many challenges in a child's life, including limiting upward‐mobility opportunities throughout the life course, and consequentially perpetuates an intergenerational cycle of poverty, inadequate nutrition, and suboptimal development. On a population basis, little is known about the relationship of early nutritional deficit and subsequent ECD. We examined this relationship in 26 LMIC.We used data from 31 UNICEF Multiple Indicator Cluster Surveys, round 4, accounting for 26 countries and 5 sub‐populations within these countries. The surveys assessed 75,731 children aged 36–59 months. Nutritional status was measured by height‐for‐age z‐scores (HAZ) based on the 2006 WHO growth standards. ECD was assessed from ten items in four domains: literacy‐numeracy, learning, physical, and social‐emotional development. We calculated the weighted mean HAZ and prevalence of each ECD indicator. We conducted linear, three‐level, mixed‐model regression analysis with random coefficients, regressing each ECD indicator on the explanatory variable HAZ while controlling for child gender and age.The mean HAZ was −0.96, with standard deviation (SD) of 0.74. The mean prevalence of literacy‐numeracy was 27.5%, while prevalence of learning and physical development was each above 90%. The mean prevalence of social‐emotional indicators ranged from 60–92%. In the random‐coefficient model assessing the relationship between HAZ and each ECD indicator, children with a one z‐score higher HAZ had a 3.64, 1.39, and 0.654 percentage‐point higher prevalence of meeting the target for literacy‐numeracy, learning, and physical development, respectively, when 36–59 months of age (all p < 0.0001). We also observed significant variability in these associations across populations with the SD of the regression coefficients being 2.27 for literacy‐numeracy, 1.16 for learning development, and 0.73 for physical development. Only one indicator of social‐emotional development had a significant small association with HAZ, (0.41, SD: 0.73).Child nutritional status, as captured in HAZ, provides a snapshot of the cumulative effect that has been imprinted on the child from the time of conception. In these populations, where on average HAZ was about one z‐score below the global standard, children with higher HAZ were more likely to meet the target for literacy‐numeracy, learning, and physical development when 36–59 months of age. Social‐emotional development was weakly associated with HAZ, but this domain is difficult to assess through a questionnaire and might be linked to other social and environmental factors. The magnitude of the associations of HAZ and ECD indicators varied substantially among the populations studied. Understanding why HAZ was strongly associated with ECD in some populations and not others requires further investigation.Support or Funding InformationFunding support from the Sackler Institute for Nutrition Science at the New York Academy of Sciences.