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Objectives: Low length-for age z-scores, a marker of chronic undernutrition, increases children’s risk of poor development. Nurturance may attenuate the effect of low length-for-age z-scores on child development. This study tests the hypotheses that greater children’s length-for age z-score is associated with better child development scores and this association varies by nurturant caregiving.
Methods: Secondary data analysis of a nutrition fortification randomized controlled trial (Project Grow Smart). Participants: 513 children age 6-14 months from rural India were enrolled and followed for 12 months. Measures: At enrollment, length was measured and converted to length-for-age z-score using WHO standards and nurturance was measured with HOME Inventory. At enrollment, 6-month and 12-month follow-up, child development was assessed by Mullens Scales for Early Learning (visual reception, fine/gross motor and receptive/expressive language domains). Analysis included linear mixed effects models accounting for repeated measures and clustering, adjusted for child age, maternal education, household assets, and Project Grow Smart interventions (micronutrient and early learning). To assess the moderating effect of nurturant caregiving, interaction terms were added in models.
Results: Mean age was 8.6 months (SD 2.2), 47% were girls, and mean HOME score was 23.8 (SD 3.7). Interaction between length-for-age z-scores and nurturant caregiving was significant for receptive language and marginally significant for fine motor. Increasing HOME scores were associated with higher scores in receptive language and fine motor among stunted children (length-for-age <-2 z-scores). Length-for-age z-scores were positively associated with all child development domains.
Conclusions: Greater infant length relates to higher developmental scores. Among stunted children, nurturant caregiving is associated with higher developmental scores.
Doris Yimgang, Department of Epidemiology and Public Health University of Maryland School of Medicine
Presenting Author
Maureen M. Black, RTI International & University of Maryland School of Medicine
Non-Presenting Author
Kristen Hurley, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Non-Presenting Author
Sylvia Fernandez-Rao, National Institute of Nutrition, Hyderabad, India
Non-Presenting Author
Krishnapillai Madhavan Nair, National Institute of Nutrition, Hyderabad, India
Non-Presenting Author
Nagalla Balakrishna, National Institute of Nutrition, Hyderabad, India
Non-Presenting Author
Kankipati Vijaya Radhakrishna, National Institute of Nutrition, Hyderabad, India
Non-Presenting Author
Kimberly B Harding, Nutrition International, Ottawa, CN
Non-Presenting Author
Gregory A Reinhart, Mathile Institute for the Advancement of Human Nutrition, Dayton, OH
Non-Presenting Author