The Effect of Early Childhood Undernutrition on Pre-Adolescent Physical Growth and Cognitive Achievement: Results from India's First Nationally Representative Panel Dataset

Abstract

Background: There is a lack of nationally representative estimates for the consequences of early child undernutrition on pre-adolescent outcomes in India. Understanding this relationship is helpful to develop interventions that not only prevent child undernutrition but also mitigate its consequences. Methods: Data from two waves of India Human Development, a nationally representative panel survey dataset was used to identify 7,868 children who were assessed for undernutrition during early childhood (0-5 years) in 2004-05 and later re-interviewed during their pre-adolescent (8-11 years) years in 2011-12. Early childhood undernutrition was assessed using the Composite Index of Anthropometric Failure (CIAF). Short stature (height-for-age z <-2), thinness (BMI <18·5 kg/m2), reading, and arithmetic skills during pre-adolescence were considered as outcomes. We used survey-weighted generalized linear models to determine the association between child undernutrition and pre-adolescent outcomes. We assessed differences in this association based on child sex and sociodemographic variables using three-way interaction terms. Results: CIAF increased the odds of short stature and thinness in the pre-adolescent period by 73% and 52%, respectively, while it decreased the odds of achieving a higher reading and arithmetic score by 20%. The disparity in outcomes based on CIAF increased with age, especially for girls. Increased level of female education within the household reduced the disadvantages of undernutrition among female children. Discussion: Early child undernutrition is associated with several adverse pre-adolescent physical and cognitive outcomes, especially among female children. Improved female education can mitigate these consequences. Female education promotion should assume a central role in Indian public health policy-making. Funding Statement: AS received support from the National Institute of General Medical Science (T32GM107000), National Center for Advancing Translational Sciences (TL1-TR001454) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1F30HD091975-03). TMS received support from the National Center for Chronic Disease Prevention and Health Promotion (5U01DP006093-04). JA received support from the National Institute on Minority Health and Health Disparities (P60-MD006912-05). JAF received support from the National Institute of Health (R01 HD092374-03), and the National Institute of Child Health and Human Development (UH3OD023348-03). Declaration of Interests: The authors have indicated they have no potential conflicts of interest to disclose. Dr. Frazier has had research support from F. Hoffmann-La Roche Ltd., Fulcrum Therapeutics, Janssen Research & Development, LLC, and has served as a consultant for Takeda Pharmaceuticals. However, these activities were not related to the research contained in this manuscript. Ethics Approval Statement: The IRB at the University of Massachusetts Medical School reviewed the protocol and exempted it from full committee review because the publicly available data contained no personal identifiable information on survey participants.