Height in mid childhood and psychosocial competencies in late childhood: evidence from four developing countries

A multi-sectoral community development intervention has a positive impact on diet quality and growth in school-age children in rural Nepal

Poor diet quality (diet diversity and animal-source food [ASF] consumption) during childhood negatively affects growth, development, behaviour and physiologic function in later life. Relatively less is known about the impact of poor diet on the growth of school-age children compared to children <5 years of age, especially in low/middle-income countries. A better understanding of delivery strategies for effective interventions to improve diet and hence growth in school-age children is needed. A 36-month longitudinal controlled impact evaluation in rural Nepal assessed the nutrition and growth of children <5 years of age in families assigned via community clusters to full package intervention (community development, training in nutrition [during pregnancy and for children <5 years] and livestock husbandry), partial package (training only) or control (no inputs). Concurrent data were collected prospectively (baseline plus additional four rounds) on school-age children (5-8 years at baseline) in these households; the present study analysed findings in the cohort of school-age children seen at all five study visits (n = 341). Diet quality improved more in the full package school-age children compared to those in partial package or control households. full package children consumed more ASF (β +0.40 [CI 0.07,0.73], p < 0.05), more diverse diets (β +0.93 [CI 0.55,1.31], p < 0.001) and had better head circumference z-scores (β +0.21 [CI 0.07,0.35], p < 0.01) than control children. In conclusion, a multi-sectoral community development intervention was associated with improvements in diet and growth of school-age children in rural Nepal even though the intervention focused on the diet of children <5 years of age. The diet and growth of school-age children can be favourably influenced by community-level interventions, even indirectly.

Understanding the mechanism of energy poverty affecting irrigation efficiency: evidence from rural China

Lower irrigation efficiency and energy poverty cast a pall on the prospects for sustainable development. However, their relationship is poorly understood, particularly in rural China. Using the China Family Panel Studies 2014-2018 waves, this study examines the impact of energy poverty (EP) on irrigation water efficiency (IWE). Result show that EP reduced IWE by 28.3 ~ 42.4%. These results are robust to a variety of estimation methods. The underlying mechanisms, as revealed by structural equation modeling, are that health and non-agricultural employment act as mediators of the EP-IWE relationship. Non-agricultural employment has a positive and statistically significant mediating effect, indicating that efforts to alleviate energy poverty are partially transmitted to IWE.

Nourishing Hope? Changes in Malnutrition and Changes in Girls' Aspirations-Evidence From the Suaahara II Adolescent Girls Panel in Nepal

PURPOSE

Malnutrition is a pressing public health challenge in South Asia with adverse consequences for adolescent girls' well-being and, potentially, aspirations as drivers of developmental progress. This study aimed to investigate associations between changes in malnutrition and changes in girls' aspirations in key life domains.

METHODS

We analyzed two-period panel data from the Suaahara II Adolescent Girls Panel (10-19 years) in Nepal (2018-2019, n = 613). Height, weight, blood samples, 24-hour dietary recalls, and indicators of girls' educational, occupational, marital, and fertility aspirations were collected. Height-for-age z-scores, body mass index-for-age z-scores, hemoglobin concentration (Hb g/dL), and dietary diversity scores for women were calculated. Through cluster-robust fixed-effects regressions, we examined whether changes in thinness (body mass index-for-age z-scores < -2 standard deviation), anemia (Hb <115 g/L nonpregnant <11 years; Hb <120 g/L nonpregnant >12 years; Hb <110 g/L pregnant), and reaching minimum dietary diversity for women were associated with changes in educational, marital, or fertility aspirations.

RESULTS

A change from thinness to no thinness increased girls' aspired ages of having a first child by 2.77 years (standard error [SE] 1.22, p = .025). A change from anemia to no anemia increased girls' aspired years of education by .54 (SE .27, p = .044). This association was stronger for postmenarche girls (b -.62, SE .29, p = .035). No associations were found between changes in minimum dietary diversity for women and any of the aspirations.

CONCLUSIONS

Thinness and anemia were negatively associated with adolescent girls' aspirations in domains of fertility and education. Multisectoral integrated policies and programs that improve adolescent nutritional status and diets have the potential to foster adolescent girls' aspirations and thereby increase their future potential.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data

OBJECTIVE

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana.

DESIGN

Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition.

SETTING

Countrywide, covering rural and urban areas in Ghana.

PARTICIPANTS

Non-pregnant adolescent girls aged 15-19 years.

RESULTS

Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted.

CONCLUSIONS

The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Adolescent Nutrition-Developing a Research Agenda for the Second Window of Opportunity in Indonesia

BACKGROUND

Recently, adolescence has been identified as a second window of opportunity for the correction of nutritional inadequacies. However, there is a lack of knowledge on evidence-based integrated nutrition strategies for adolescents in Indonesia.

OBJECTIVE

To provide a research agenda and the prioritization of research actions to tackle outstanding knowledge gaps on adolescent nutrition in Indonesia.

METHODS

A preliminary set of research topics was listed based on a desk study of the academic literature and policy documents. Second, a stakeholder meeting was held to further identify and discuss research topics related to adolescent nutrition in Indonesia. Third, an online survey was conducted in which respondents were asked to indicate priority research themes for the next 3 to 5 years and to rank a total of 23 research questions.

RESULTS

Most (52%) of the respondents who returned the survey (n = 27) prioritize research on implementation and program evaluation, while 30% prefer descriptive and explanatory research, and 19% place priority with intervention and discovery research. However, when we followed up with specific topics for each of these broad research areas, a more nuanced picture emerged, with intervention and discovery research taking a more prominent standing.

CONCLUSIONS

In order to support the design, implementation, and effectiveness of integrated nutrition programs for Indonesian adolescents, in-depth studies should question the best intervention strategies, modes of delivery, and long-term outcomes, while nationwide and disaggregated data should investigate associations and trends over time and identify vulnerable groups.

Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana

Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487).

Perspective: Challenges in Use of Adolescent Anthropometry for Understanding the Burden of Malnutrition

Improving nutritional status during adolescence is an opportunity to improve the lives of this generation and the next. Estimating the burden of malnutrition at a population level is fundamental to targeting interventions and measuring progress over time, and for adolescents, we usually depend on survey data and the 2007 WHO Growth Reference to do so. There is substantial risk of misguided conclusions regarding adolescent prevalence estimates, however, when underlying methodological limitations of the indicators and reference are not adequately considered. We use national prevalence estimates among girls and young women 10-22 y of age from the 2014 State of Food Security and Nutrition in Bangladesh report as an example to demonstrate that determining the true prevalence of undernutrition, overweight, and obesity is complicated by racial/ethnic variation across populations in timing of the adolescent growth spurt, growth potential, and body build. Further challenging the task are inherent limitations of the body mass index as an indicator of thinness and adiposity, and cutoffs that poorly distinguish a well-nourished population from a malnourished one. We provide recommendations for adolescent nutrition policy and program decision-making, emphasizing the importance of 1) critically interpreting indicators and distributions by age when using the 2007 WHO Growth Reference; 2) examining what is happening before and after adolescence, when interpretation of anthropometry is more straightforward, as well as trends over time; and 3) complementing anthropometry with other information, particularly dietary intake. Finally, we advocate that nutrition researchers prioritize exploration of better methods to predict peak height velocity, for development of standardized indicators to measure dietary quality among adolescents, and for studies that will illuminate causal paths so that we can effectively improve adolescent dietary intake and nutritional status.

The structural relationship between early nutrition, cognitive skills and non-cognitive skills in four developing countries

This study provides evidence about how cognitive and non-cognitive skills are acquired during childhood in four developing countries (Ethiopia, India, Peru and Vietnam), highlighting the role of early nutrition as a determinant in this process. An increase of one standard deviation in height-for-age at the age of 1 is found to have a total effect on cognitive skills at age 8 by 5.4 percent in Ethiopia, 9.0 percent in India, 7.6 percent in Peru and 8.4 percent in Vietnam. The corresponding total effect on non-cognitive skills is 1.1 percent in Ethiopia, 3.4 percent in India, 2.6 percent in Peru and 1.7 percent in Vietnam. The evidence suggests the effect of early nutrition on non-cognitive skills is indirect, mediated by cognitive skills. The effect is also relatively small in magnitude.

Do boys eat better than girls in India? Longitudinal evidence on dietary diversity and food consumption disparities among children and adolescents

This paper examines the dynamics of gender-based disparities in the intra-household allocation of food during childhood and adolescence in Andhra Pradesh and Telangana by using three rounds of longitudinal data from two cohorts. While boys are advantaged at all ages (except for the Younger Cohort at 12 years old), the pro-boy gap widens markedly at 15 years old. Specifically, mid-adolescent girls tend to consume fewer protein- and vitamin-rich foods such as eggs, legumes, root vegetables and fruit. This result is robust to gender differences between adolescents in terms of puberty onset, school enrolment, time use and dietary behaviours. Finally, gender disparities in dietary diversity during early and mid-adolescence do not vary by maternal education, poverty or place of residence, whilst they are moderated by levels of caregiver's educational aspirations at 15 years old.