Growth Indices, Anemia, and Diet Independently Predict Motor MilestoneAcquisition of Infants in South Central Nepal

Community and International Nutrition

INTRODUCTION

Gross motor development is an important aspect of

the developmentof young children

Children begin to explore their environments

Engage in new experiences that promote learning and development

INTRODUCTION

Growth faltering

PREVALENT in developing countries

INFECTION MALNUTRITION

INTRODUCTION

Limited variety of complementary foods ASSOCIATED

Low nutrient density adequacy of thefoods

CAUSEMalnutrition and

developmental delays

INTRODUCTION

•Animal protein intake was positively associated with earlier walking acquisition among Guatemalan infants

•Delays in motor milestone acquisition, including walking, were found among cohorts of:

Stunted, underweight Indonesian

Stuntedand wasted Pakistani infants

Zanzibari Infants,

Guatemalan infants

INTRODUCTION

•Several controversies remain:▫Is there an ordinal relation between motor

milestones?▫Is linear growth the salient variable or is

wasting as important in walking acquisition?▫Do anemia and growth have independent

effects on walking in populations of children outside of Zanzibar?

▫Are dietary factors merely a proxy for anemia?

METHODS•Study population

▫Cross-sectional community based investigation of baseline characteristics of children enrolled in: a substudy of a randomized, placebo-controlled,

clinical trial of zinc and/or iron-folic acid supplementation on: Childhood mortality, morbidity, Growth, and development

Between January and March 2002 that occurred in the lowland Terai region of south central Nepal in Sarlahi District, which borders Northern India

METHODS• Motor development was evaluated using a 14-item, prospective,

ordinal pictorial scale of motor milestones.

• Blood was collected using a heel-prick method to extract 3 drops of blood from each child.▫ The first was wiped away▫ The second and third were used for testing erythrocyte

protoporphyrin (EP)4 and hemoglobin with a Hemoglobin Photometer (HemoCue) and a Hematofluorometer(AVIV Biomedical), respectively.

• Anthropometric measures included:▫ Weight▫ Recumbent length ▫ Mid-upper arm circumference (MUAC)▫ Head circumference.

Data Analysis

•Data were entered into SQL Server 7.0 and analyzed using SPSS 12.0.

•Stunting, wasting, and underweight were defined, respectively as length-for-age, length-for-weight, and weight-for-age less than 2 Z-scores.

•The definition of anemia used in this analysis was a hemoglobin concentration 105 g/L.

METHODS• A scale was created as a means of summarizing socioeconomic

status (SES); 12 of the 17 related items were retained for the scale.

• Principal components analysis was used to extract the factors for the scale

• The most comprehensive factor with the largest eigenvalue 1 was selected for reliability analysis.

• Cronbach’s was used to assess the internal consistency of the selected items. The reliability of the SES scale was good ( 0.78).

• A higherscore on the SES scale reflected a greater number of possessions.

RESULTS•Among the 485 children

▫One-third were stunted (33.7%)▫One-fifth were wasted (20.6%)▫More than onehalf were underweight (52.7%)

•Mean hemoglobin concentration was below both the recommended cutoff values of 105 g/dL

•Anemia was prevalent, but not very severe: 2.1% of the children had a hemoglobin concentration 70 g/L.

HALF OF THEM CAN

RESULTS• Could sit without support by 6 mo• Crawl by 7 mo• Walk with support by 11 mo• Walk without support by 14 mo

NEPALI CHILDREN

1.5 LATER THAN

WESTERN POPULATION

S

1 MO EARLIER

THAN INDONESIAN

CHILDREN

1 MO EARLIER

THAN ZANZIBAR CHILDREN

ATTAINED MILESTONE

WALKERS AND NONWALKERS DIFFER SIGNIFICANTLY

WALKERS WERE OLDER

WALKERS WERE LESS UNDERWEIGHT

WALKERS ATE MORE ANIMAL SOURCE FOODS

In multivariate regression models

AGE LENGTH FOR AGE

WEIGHT FOR AGE

ANEMIAMEAT

CONSUMPTION

Were significant predictorsof walking in the Nepali cohort

•Although there are occasional individual children who show some transpositions in the ordering of motor milestones, the acquisition of these milestones is ordered across different cultures and levels of nutritional risk in different populations.

RESULTS

•There is an independent effect of 2 anthropometric indicators, anemia, and meat intake on:▫Walking acquisition and contributes to

earlier evidence that motor development is sensitive to nutritional factors.

RESULTS

•Caste, but not sex or SES, was predictive of walking acquisition

•Nepali children who consumed meat were higher than the odds of walking for children who consumed animal source foods, including meat, eggs, and nonhuman milk.

CONCLUSSION

•The present data indicate that the variability of nutritional status among infants and toddlers accounts for part of the variance in gross motor development

•Nutrition factors affect a developmental system

Q1. Is there any new information you learn from this paper? Please mention briefly

•There are new informations that we learn from this paper. Nepali children who we thought are living in rural areas have a better growth rate than Indonesian children from the same age, and it shows the lack of animal source food that Indonesian children consume.

•And it’s quite new for us to learn that lower caste children are able to walk faster than higher caste children. Maybe there are more factors that influence this result.

Q2. Is there any information which is not in line with you? Please mention briefly.

•Yes there is, when we read it is reported that the higher SES children have slower motor growth, we thought that higher SES children were fed better and the parents have higher education. But it is not always promising that it will ensure the growth speed. We thought that there are more factors that contribute to the growth other than foods.

Q3. What do you think the paper can help to improve nutritional status of Indonesian children/people?

• It can help us by showing us that Indonesian children growth is a lot more slower than advanced countries. Leave alone the western counterpart, Nepali children are even more well fed and have better growth than Indonesian children, and it is a lesson for us to improve the nutritional status of Indonesian children.

• Maybe It’s time to improve counseling to eat more animal sourced foods for Indonesian children. And it should be administered since younger age than what we thought.