Nutritional status and social behavior in preschool children: the mediating effects of neurocognitive functioning

Nurturing development: how a mother's nutrition shapes offspring's brain through the gut

Pregnancy is a transformative period marked by profound physical and emotional changes, with far-reaching consequences for both mother and child. Emerging research has illustrated the pivotal role of a mother's diet during pregnancy in influencing the prenatal gut microbiome and subsequently shaping the neurodevelopment of her offspring. The intricate interplay between maternal gut health, nutrition, and neurodevelopmental outcomes has emerged as a captivating field of investigation within developmental science. Acting as a dynamic bridge between mother and fetus, the maternal gut microbiome, directly and indirectly, impacts the offspring's neurodevelopment through diverse pathways. This comprehensive review delves into a spectrum of studies, clarifying putative mechanisms through which maternal nutrition, by modulating the gut microbiota, orchestrates the early stages of brain development. Drawing insights from animal models and human cohorts, this work underscores the profound implications of maternal gut health for neurodevelopmental trajectories and offers a glimpse into the formulation of targeted interventions able to optimize the health of both mother and offspring. The prospect of tailored dietary recommendations for expectant mothers emerges as a promising and accessible intervention to foster the growth of beneficial gut bacteria, potentially leading to enhanced cognitive outcomes and reduced risks of neurodevelopmental disorders.

Adherence to dietary guidelines associated with lower medical service utilization in preschoolers: a longitudinal study

OBJECTIVE

We aimed to evaluate the association between dietary guideline adherence and overall, outpatient, and emergency medical service utilization in Taiwanese preschoolers.

METHODS

We selected 614 preschoolers (2-6 years) who had one day of 24-h dietary recall data from the 2013-2016 Nutrition and Health Survey in Taiwan. The Taiwanese Children Healthy Eating Index (TCHEI) was developed on the basis of Taiwanese Food-Based Dietary Guidelines; it assesses dietary adequacy and eating behavior. Data on the participants' outpatient and emergency medical service utilization were obtained for 2013-2018 from the National Health Insurance Research Database. A multivariable generalized linear model was used to evaluate the association between the TCHEI and medical service utilization for all disease and respiratory diseases.

RESULTS

After adjustment for confounding factors, children aged 2-3 years in the Tertile (T) 2 and T3 groups of the TCHEI exhibited 25% (95% CI 0.69-0.83) and 16% (95% CI 0.77-0.92) lower overall medical visits, respectively. The same pattern was noted in the outpatient and emergency visits for all diseases and respiratory diseases. The children aged 4-6 years in the T2 group exhibited 15% (95% CI 0.80-0.91) and 11% (95% CI 0.82-0.97) lower overall visits and visits for respiratory diseases, respectively. Moreover, preschoolers in the T2 group exhibited lower overall medical expenditures than did those in the T1 group.

CONCLUSIONS

TCHEI score was positively correlated with better nutritional status. Optimal dietary intake associated with lower medical service utilization among Taiwan preschoolers.

Mother-child pairs' eating and feeding behaviours in two different nutritional status from two distinct provinces

Nutrition plays a crucial role for the bio-psycho-social growth and development of children. Mother-child pairs' eating-feeding problems can be hypothesized to relate to the child's nutritional status and living area. Our focus was to assess maternal attitudes and children's eating habits in thin and normal-weight children across two cities characterized by distinct socioeconomic and demographic profiles: Ankara and Şanlıurfa. This double case-control study included the mothers whose children are aged between 2 and 7 years old in both cities. Figure Rating Scale, Child Feeding Questionnaire and Behavioral Pediatrics Feeding Assessment Scale were filled by mothers of children. The mothers of thin children were concerned more about the weight of their children, felt more responsible for feeding their children, and use of pressured them to eat more frequently compared to normal-weight children's mothers in both cities. In Ankara, the duration of breastfeeding is longer, using formula is rarer and starting complementary food on time is more common, mother had higher scores on perceived responsibility, perceived child weight, and concern about child weight subscales; lower score on the restriction subscale compared to Şanlıurfa. Mothers of both thin and normal weight children in Şanlıurfa rated their children as weaker compared to those in Ankara. In conclusion, child eating behaviors and parental feeding practices were associated with the weight of children depending on demographic and sociocultural differences. Implementing customized, location-specific preventive educational initiatives on child feeding will not only foster behavioral changes but also yield valuable insights for shaping future interventions.

Modeling the Risk Factors of Undernutrition among Children below Five Years of Age in Uganda Using Generalized Structural Equation Models

INTRODUCTION

The prevalence of undernutrition among children below five years of age, in Uganda and the world over, remains very high. About 45% of all global deaths among children below five years of age are attributed to undernutrition. A number of studies using different statistical approaches affirm this effect, yet some factors indicate the influence of other factors within the system. This study, therefore, uses a method that demonstrates how different variables feed into each other.

AIM

The aim of this study was to establish the major factors associated with an increased likelihood of undernutrition and the paths showing how these risk factors influence undernutrition.

METHODS

Data from the Uganda Demographic and Health Survey (UDHS, 2016) were used for this study. A sample of 4530 children, whose age, height, and weight measurements were recorded, was considered for this study. Additionally, the study used generalized structural equation models to identify the multifaceted natures and paths of the risk factors that influence undernutrition among children below five years of age. The study relied on the UNICEF 2020 conceptual framework to identify and analyze the direct and indirect effects of these risk factors of undernutrition.

RESULTS

From the perspective of a male child, having a perceived small size at birth, a low birth weight, being breastfed for less than 6 months, having no formal education from mothers, limited income-generating opportunities, a low wealth status, and notable episodes of diarrhea were among the key factors associated with an increased likelihood of undernutrition. The identified paths were as follows: (i) Having no education, as this was associated with limited working opportunities and a low income, which increases the likelihood of low household wealth status, hence increasing the chances of undernutrition. (ii) Exposure to a rural setting was associated with an increased likelihood of undernutrition through association with poor and or low employment levels within the rural areas. (iii) A shorter duration of breastfeeding was associated with children in urban areas, resulting in an increased likelihood of undernutrition. (iv) Children aged between 6 and 47 months had a higher likelihood of undernutrition.

CONCLUSIONS

An approach that addresses and recognizes all these factors at different levels, along the established paths, should be implemented to effectively reduce undernutrition among children below five years of age.

Socioeconomic disparities in Rwanda's under-5 population's growth tracking and nutrition promotion: findings from the 2019-2020 demographic and health survey

BACKGROUND

Regular growth monitoring can be used to evaluate young children's nutritional and physical health. While adequate evaluation of the scope and quality of nutrition interventions is necessary to increase their effectiveness, there is little research on growth monitoring coverage measurement. The purpose of this study was to investigate socioeconomic disparities in under-5 Rwandan children who participate in growth monitoring and nutrition promotion.

METHODS

We used data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS), which included 8092under-5 children. Percentage was employed in univariate analysis. To examine the socioeconomic inequalities, concentration indices and Lorenz curves were used in growth monitoring and nutrition promotion among under-5 children.

RESULTS

A weighted prevalence of 33.0% (95%CI: 30.6-35.6%) under-5 children growth monitoring and nutrition promotion was estimated. Growth monitoring and nutrition promotion among under-5 children had higher uptake in the most disadvantaged cohort, as the line of equality sags below the diagonal line in Lorenz curve. Overall, there was pro-poor growth monitoring and nutrition promotion among under-5 in Rwanda (Conc. Index = 0.0994; SE = 0.0111). Across the levels of child and mother's characteristics, the results show higher coverage of under-5 growth monitoring and nutrition promotion in the most socioeconomic disadvantaged cohort.

CONCLUSION

The study found a pro-poor disparity in growth monitoring and nutrition promotion among under-5 children in Rwanda. By implication, the most disadvantaged children had a higher uptake of growth monitoring and nutrition promotion. The Rwanda government should develop policies and programmes to achieve the universal health coverage for the well-off and underserved population.

'It was called a grab bag and nobody wanted to grab them': Teachers' perceptions of school lunches during the COVID-19 pandemic - a regional case study

Background

The COVID-19 pandemic brought changes to primary school lunches leading to concerns over nutritional quality and uptake of lunches by vulnerable children. Regional data from Tayside, Scotland, showed that only 55% of children who were eligible for free school meals took these (normal uptake pre-pandemic was 66%). The current work aimed to identify teachers' perceptions of meal provisioning in primary schools during the first year of the COVID-19 pandemic.

Design and methods

A cross-sectional online survey was carried out among primary school teachers across Tayside, Scotland. Using an online survey (21 questions combining multiple choice formats and open text) and interviews, primary school teachers shared their views on food quality, quantity, meal choices and factors influencing uptake of primary school lunches. Interviews were recorded, transcribed and thematically analysed with respect to factors influencing consumption.

Results

The survey was completed by 41 teachers and 8 participated in a follow up interview. Around one-third (29%) of primary school teachers believed the quality of lunches had decreased and cited poor appearance of food, use of takeaway containers and food wastage. The lunch format was viewed negatively principally relating to the substitution of hot lunches with cold sandwiches, portion sizes, choice and perceived value for money. Concerns were expressed about acceptability and how far the meals contributed to food security.

Conclusions

Further work on food provisioning is needed in order to identify ways to provide a nutritional safety net for vulnerable children.

A systematic review and meta-analysis of the association of dietary diversity with undernutrition in school-aged children

BACKGROUND

Malnutrition in childhood has lasting consequences; its effects not only last a lifetime but are also passed down from generation to generation such as short stature, school-aged children are the most vulnerable section of the population and require special attention, including nutrition.

METHOD

We searched Medline through PubMed, Scopus, and Web of Science to identify all observational studies published before Jun 2022. Observational studies with a pediatric population aged 5-18 years that evaluated risk estimate with 95% confidence intervals the relationship between dietary diversity and undernutrition (wasting, stunting, and thinness) were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed.

RESULTS

This is a first systematic review and meta-analysis with a total of 20 studies were eligible (n = 18 388). Fourteen data evaluated stunting resulting in a pooled effect size estimated odds ratio of 1.43 (95% CI: 1.08-1.89; p = 0.013). Ten data evaluated Thinness resulting in a pooled effect size estimated odds ratio of 1.10 (95% CI: 0.81-1.49; P = 0.542). Two studies were revealed wasting with a odds ratio of 2.18 (95% CI: 1.41-3.36; p-value < 0.001).

CONCLUSION

According to the conclusions of this meta-analysis of cross-sectional studies, inadequate dietary diversity increases the risk of undernutrition in growth linear but not in thinness in school-aged children. The findings of this analysis suggest that initiatives that support improvements to the diversity of children's diets to reduce the risk of undernutrition may be warranted in LMICs.

Health-Related Quality of Life in Childhood and Adolescence: The Interrelation with Level of Adherence to Mediterranean Diet and Dietary Trajectories: Highlights from the DIATROFI Program (2021-2022)

Children's dietary habits can have a key role in contributing to an improvement in their Health-Related Quality of Life (HRQoL). This study aims to assess the connection between Mediterranean diet adherence and HRQoL in a sample of Greek students, utilizing data from the DIATROFI program. The parents of 3774 students (mean age 7.8 (2.6) years) reported their children's HRQoL and level of adherence to the Mediterranean dietary pattern at the beginning and end of the 2021-2022 school year. At baseline, most students' adherence was characterized as moderate (55.2%) or high (25.1%). Students with moderate or high adherence tο the Mediterranean diet were less likely to report a total HRQoL below the median at baseline (OR = 0.56, 95%CI = 0.44, 0.70), along with all its dimensions (physical, emotional, social, and school functions). A one-unit improvement in KIDMED score _{(beginning-end of schoolyear)} was associated with the likelihood of an improvement in total HRQoL _{(beginning-end of schoolyear)} (OR = 1.09, 95%CI = 1.02, 1.17), emotional (OR = 1.09, 95%CI = 1.02, 1.17), and social functions (OR = 1.13, 95%CI = 1.05, 1.22), but not with physical and school functions. The health benefits of the Mediterranean diet in children may not be limited to disease prevention but also extend to their overall wellbeing.

Dietary interventions, the gut microbiome, and aggressive behavior: Review of research evidence and potential next steps

Research in biosocial criminology and other related disciplines has established links between nutrition and aggressive behavior. In addition to observational studies, randomized trials of nutritional supplements like vitamins, omega-3 fatty acids, and folic acid provide evidence of the dietary impact on aggression. However, the exact mechanism of the diet-aggression link is not well understood. The current article proposes that the gut microbiome plays an important role in the process, with the microbiota-gut-brain axis serving as such a mediating mechanism between diet and behavior. Based on animal and human studies, this review synthesizes a wide array of research across several academic fields: from the effects of dietary interventions on aggression, to the results of microbiota transplantation on socioemotional and behavioral outcomes, to the connections between early adversity, stress, microbiome, and aggression. Possibilities for integrating the microbiotic perspective with the more traditional, sociologically oriented theories in criminology are discussed, using social disorganization and self-control theories as examples. To extend the existing lines of research further, the article considers harnessing the experimental potential of noninvasive and low-cost dietary interventions to help establish the causal impact of the gut microbiome on aggressive behavior, while adhering to the high ethical standards and modern research requirements. Implications of this research for criminal justice policy and practice are essential: not only can it help determine whether the improved gut microbiome functioning moderates aggressive and violent behavior but also provide ways to prevent and reduce such behavior, alone or in combination with other crime prevention programs.

Dietary Intake among Children Attending Childcare Centers: Impact of the New CACFP Meal Guidelines

Through the Healthy, Hunger-Free Kids Act of 2010, USDA (US Department of Agriculture) made the first major changes in the CACFP (Child and Adult Care Food Program) meal and snack menu patterns. Childcare centers that serve low-income families qualify to participate and receive reimbursement for meals and snacks served. The purpose of this study was to assess what changes in children’s dietary behaviors occurred as a result of the new CACFP meal pattern requirements. This study evaluated these changes at childcare centers operating in Houston and San Antonio, Texas, USA, areas enrolled in the CACFP, pre- (Spring 2016) and post-implementation (Fall 2016–Spring 2017) of the new meal patterns. Dietary intake was assessed via observations of children, 3–5 years old, conducted at breakfast, lunch, and snack times. Results showed improvements in adjusted means of several nutrients and food groups consumption, post-implementation of new CACFP meal guidelines compared to baseline, specifically intake of whole grains, milk, and juice. Additional studies are needed to confirm the impact of the revised CACFP meal patterns along with strategies to assist providers in meeting the new standards to increase the access to and intake of items in accordance with the CACFP meal pattern requirements in childcare settings.

Early Childhood Dietary Intake and Subsequent Socioemotional and Cognitive School Readiness Among Australian Children

Dietary intake can affect the physical, cognitive, and socioemotional development of young children. Few studies have explored the relationships between dietary intake and the cognitive and socioemotional dimensions of school readiness. This study aimed to investigate the longitudinal associations between children's dietary intake in early childhood, and cognitive and socioemotional school readiness indicators at age 4-5 years using data from the Longitudinal Study of Australian Children. A total of 4,253 children were included in the analysis. Multiple linear regression models were built to investigate whether dietary intake (measured by questionnaire at parent interview) at age 2-3 years predicted school readiness indicators of socioemotional and behavioral functioning (measured by parent-reported Strengths and Difficulties Questionnaire [SDQ total score and pro-social scale]), verbal (assessed by Peabody Picture Vocabulary Test-Third Edition [PPVT-III]) and nonverbal (assessed by "Who Am I" test [WAI] cognitive skills) at age 4-5 years. Furthermore, using cross-sectional data at age 4-5 years, four multiple linear regression models were built to investigate if dietary intake was correlated with the aforementioned school readiness indicators. All models were adjusted for potential confounders. It was found that every one-point increase in child dietary intake score at age 2-3 years led to a decrease in SDQ total score by 0.19 (95% confidence interval [CI] = [0.10, 0.28], and an increase in SDQ pro-social scale, WAI score and PPVT score by 0.07 (95% CI = [0.03, 0.10]), 0.27 (95% CI = [0.13, 0.41]), and 0.20 (95% CI = [0.09, 0.30]), respectively, at age 4-5 years. Children's dietary intake was also a correlate of their school readiness at age 4-5 years. These results add to the limited evidence base suggesting that children's early dietary intake may play an important role in later socioemotional and behavioral development, and the development of cognitive skills, which are critical school readiness indicators.

Protein-energy Supplementation in Early-life Decreases the Odds of Mental Distress in Later Adulthood in Guatemala

BACKGROUND

Prevalence of mental health concerns is growing worldwide, along with lack of access to and receipt of needed treatment. Current gaps in treatment provision have led to exploring alternative methods of prevention, with research linking nutrition and mental health, of particular relevance in low- and middle- income countries with high prevalence of undernutrition.

OBJECTIVES

To examine whether exposure to a protein-energy nutritional supplement during the first 1000 days of life decreased odds of mental distress in adulthood among men and women in Guatemala compared to receiving a low energy-no protein supplement or supplementation outside the 1000-day window.

METHODS

Data from participants (n = 1249) in a longitudinal cohort protein-energy supplementation trial (early life, supplementation data from 1969-77, ages 0-7 years; life course, outcome data from 2017-2018 follow-up, ages 40-57 years) were analyzed for associations between nutrition in the first 1000 days and mental distress in adulthood (SRQ-20), controlling for early life variables and current life stress; life course variables (e.g., education) were examined as potential mediators of this relationship. Generalized linear mixed models and zero-inflated Poisson generalized linear mixed models were utilized.

RESULTS

Both partial and full supplementation with Atole during the first 1000 days were associated with 63% (95% CI: 0.16, 0.87) and 56% (95% CI: 0.19, 1.03) lower odds, respectively, of experiencing mental distress in adulthood. Results did not differ by sex. These inverse relationships remained relatively unchanged (partial OR = 0.34 [95% CI: 0.14, 0.83]; full OR = 0.38 [95% CI: 0.16, 0.92]) after controlling for early life and life course variables, including life stress.

CONCLUSIONS

Protein-energy supplementation during the first 1000 days of life in Guatemala where undernutrition is prevalent may reduce prevalence of later mental distress in adulthood. This effect appears to occur directly, rather than indirectly through pathways of life course variables such as education, wealth, and marital status.

Impaired social cognition caused by perinatal protein malnutrition evokes neurodevelopmental disorder symptoms and is intergenerationally transmitted

Nutritional inadequacy before birth and during postnatal life can seriously interfere with brain development and lead to persistent deficits in learning and behavior. In this work, we asked if protein malnutrition affects domains of social cognition and if these phenotypes can be transmitted to the next generation. Female mice were fed with a normal or hypoproteic diet during pregnancy and lactation. After weaning, offspring were fed with a standard chow. Social interaction, social recognition memory, and dominance were evaluated in both sexes of F1 offspring and in the subsequent F2 generation. Glucose metabolism in the whole brain was analyzed through preclinical positron emission tomography. Genome-wide transcriptional analysis was performed in the medial prefrontal cortex followed by gene-ontology enrichment analysis. Compared with control animals, malnourished mice exhibited a deficit in social motivation and recognition memory and displayed a dominant phenotype. These altered behaviors, except for dominance, were transmitted to the next generation. Positron emission tomography analysis revealed lower glucose metabolism in the medial prefrontal cortex of F1 malnourished offspring. This brain region showed genome-wide transcriptional dysregulation, including 21 transcripts that overlapped with autism-associated genes. Our study cannot exclude that the lower maternal care provided by mothers exposed to a low-protein diet caused an additional impact on social cognition. Our results showed that maternal protein malnutrition dysregulates gene expression in the medial prefrontal cortex, promoting altered offspring behavior that was intergenerationally transmitted. These results support the hypothesis that early nutritional deficiency represents a risk factor for the emergence of symptoms associated with neurodevelopmental disorders.

Malnutrition and the microbiome as modifiers of early neurodevelopment

Malnutrition refers to a dearth, excess, or altered differential ratios of calories, macronutrients, or micronutrients. Malnutrition, particularly during early life, is a pressing global health and socioeconomic burden that is increasingly associated with neurodevelopmental impairments. Understanding how perinatal malnutrition influences brain development is crucial to uncovering fundamental mechanisms for establishing behavioral neurocircuits, with the potential to inform public policy and clinical interventions for neurodevelopmental conditions. Recent studies reveal that the gut microbiome can mediate dietary effects on host physiology and that the microbiome modulates the development and function of the nervous system. This review discusses evidence that perinatal malnutrition alters brain development and examines the maternal and neonatal microbiome as a potential contributing factor.

Population policy, family size and child malnutrition in Vietnam - Testing the trade-off between child quantity and quality from a child nutrition perspective

This paper estimates the quantity-quality (QQ) trade-off of children from a child nutrition perspective, using data on 2000 children born in 2001-2002 from the Young Lives project in Vietnam. Using the sex of the first-born in the family as an instrumental variable for family size, we found that having an additional sibling lowers a 5-year-old Vietnamese child's height-for-age and weight-for-age Z scores by 0.3 and 0.26 standard deviations (SDs), respectively. This finding is robust to a series of checks, providing strong evidence of the quantity-quality trade-off of children. In more policy-relevant terms, our estimates suggest that the violation of Vietnam's Two-Child policy (i.e., having more than two children) may have caused reductions in 5-year-old Vietnamese children's height-for-age and weight-for-age by, respectively, 0.49 and 0.57 SDs.

Nutrition, Cognition, and Social Emotion among Preschoolers in Poor, Rural Areas of South Central China: Status and Correlates

Existing empirical evidence suggests that the prevalence of undernutrition in remote and poor, rural areas is still high among Chinese children. While evidence reveals that undernutrition may detrimentally affect child development, studies focusing on rural Chinese preschoolers are sparse. Using the baseline survey of a preschool's free nutritious lunch pilot program, this study examined the relationship between child undernutrition and developmental outcomes among a preschool-aged sample in poor, rural areas of China. We conducted the baseline survey in Hunan province in south central China in September 2018. A total of 1293 preschoolers living in two (then) nationally designated poverty counties in rural Hunan served as our study sample. Children's nutritional statuses were measured using height-for-age z-score, weight-for-age z-score, and anemia, while their cognitive and socio-emotional skills were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and Strengths and Difficulties Questionnaire (SDQ), respectively. We find that 33% of sample preschoolers were anemic, whereas the incidences of stunting and wasting were 11% and 2%, respectively. About 54% of the sample children had delay in at least one of the developmental domains measured in this study. Our findings provide suggestive evidence supporting that children from certain backgrounds tend to experience worse nutritional and developmental outcomes than their counterparts. After controlling for socioeconomic status, we observed that both anemia and stunting were negatively associated with children's cognitive performance; however, they were not associated with socio-emotional performance. As such, this study suggests that free lunch programs have the potential to change children's developmental trajectory in preschool. We believe that our results will contribute to the debate surrounding whether the nutritious lunch program in China should be expanded to the preschool education level.

Dietary Intakes, Patterns, and Determinants of Children Under 5 Years from Marginalized Communities in Odisha: A Cross-sectional Study

Pre-school age (3–5 years) children are vulnerable to malnutrition due to poor dietary intake, dietary habits, and socio-economic conditions. Children from marginalized families are more vulnerable than non-marginalized families due to limited access to health- and nutrition-related services, besides other socio-economic factors. This study was done to assess the dietary intakes, patterns, and determinants of pre-school age (3–5 years) children from marginalized populations in two districts of Odisha. We used three different questionnaires, namely general demographic information, single 24-h recall dietary survey, and food frequency questionnaire, to collect data. Dietary patterns were obtained using principal component analysis, and the recommended dietary allowance (RDA) method was applied to estimate the prevalence of inadequate intake. A general linear model of regression was used to investigate the relationship of dietary patterns scores with independent variables. A total of 86 boys (57.3%) and 64 girls (42.7%) were recruited for the study. The majority (more than two-third) of the children had <70% of RDA of iron, vitamin C, and zinc. The three dietary components that best described the dietary patterns among children in the study were vegetarian, non-vegetarian, and mixed patterns. They explained 54.9% of the variability. The ‘vegetarian’ dietary pattern was inversely associated with children whose mothers were illiterate (p = 0.005), who lived in families having per capita family monthly income less than INR 786 (10.3 US$) (p = 0.007), and who were first born (p = 0.04). The dietary patterns may help interventionists in designing programs aimed at preventing malnutrition and chronic diseases among children in marginalized communities.

Global DNA methylation and cognitive and behavioral outcomes at 4 years of age: A cross-sectional study

BACKGROUND

Accumulating evidence suggests that breastfeeding exclusivity and duration are positively associated with child cognition. This study investigated whether DNA methylation, an epigenetic mechanism modified by nutrient intake, may contribute to the link between breastfeeding and child cognition. The aim was to quantify the relationship between global DNA methylation and cognition and behavior at 4 years of age.

METHODS

Child behavior and cognition were measured at age 4 years using the Wechsler Preschool and Primary Scale of Intelligence, third version (WPPSI-III), and Child Behavior Checklist (CBC). Global DNA methylation (%5-methylcytosines (%5mC)) was measured in buccal cells at age 4 years, using an enzyme-linked immunosorbent assay (ELISA) commercial kit. Linear regression models were used to quantify the statistical relationships.

RESULTS

Data were collected from 73 children recruited from the Women and Their Children's Health (WATCH) study. No statistically significant associations were found between global DNA methylation levels and child cognition or behavior (p > .05), though the estimates of effect were consistently negative. Global DNA methylation levels in males were significantly higher than in females (median %5mC: 1.82 vs. 1.03, males and females, respectively, (p < .05)).

CONCLUSION

No association was found between global DNA methylation and child cognition and behavior; however given the small sample, this study should be pooled with other cohorts in future meta-analyses.

Prenatal lead exposure modifies the association of maternal self-esteem with child adaptive ability

BACKGROUND

A child's adaptive ability is important for personal career and social development. Maternal self-esteem may help shape a child's behavior. This study aims to investigate whether maternal self-esteem measured when their children were toddlers predicts their children's adaptive skills at school age, and whether prenatal lead exposure modifies such a relationship.

METHODS

We assessed prenatal lead exposure using cord blood lead and maternal bone lead around delivery (tibia and patella lead measured in vivo by K-x-ray-fluorescence) among 192 mother-child pairs investigated in Mexico from 1994 to 2011. Maternal self-esteem was measured using the Coopersmith-Self-esteem-Inventory when children were 2 years old. When children were 7-to-15 years old, we measured children's blood lead levels and administered the 2nd edition of Behavior-Assessment-System-for-Children (BASC-2) parent-rating-scales (PRS) and Self-Reports of Personality (SRP) to evaluate children's adaptive skills.

RESULTS

Median (P25, P75) values for maternal patella and tibia lead, cord blood lead and children's current blood lead levels were 12.6 (3.2, 21.7) μg/g, 10.2 (4.1, 16.0) μg/g, 5.5 (3.5, 8.1) μg/dL and 2.7 (2.0, 4.0) μg/dL, respectively. In adjusted models, increased maternal self-esteem was associated with increased adaptive T-scores on the BASC-2 PRS and SRP scales. This relationship was weaker in high prenatal lead-exposure groups (high cord blood lead or patella lead groups, P25P100) compared with low prenatal lead-exposure (low cord blood lead or patella lead groups, P1P25) groups (P-interaction values < 0.10). No significant interactions between maternal tibia lead and self-esteem on children's adaptive T-scores were observed (P-interaction values > 0.10).

CONCLUSIONS

Toddlers of mothers with high (vs. low) self-esteem have better adaptive abilities when they are of school-age. Prenatal lead exposure may attenuate or eliminate this positive association.

The role of nutrition in integrated early child development in the 21st century: contribution from the Maternal and Child Nutrition journal

Even though it is widely recognized that early childhood development (ECD) is one of the most important predictors of future social capital and national productivity, the recently published ECD Lancet Series reports that about 250 million children under 5 years are at risk of not reaching their developmental potential, mainly as a result of poverty and social injustice. So why is this and what will it take to reverse this situation? The purpose of this special issue is to highlight important contributions from previously published articles in Maternal & Child Nutrition to the field of nutrition and ECD. The collection of papers presented in this special issue collectively indicates that although nutrition-specific interventions are essential for child development, they are not sufficient by themselves for children to reach their full developmental potential. This is because ECD is influenced by many other factors besides nutrition, including hand washing/sanitation, parenting skills, psychosocial stimulation, and social protection. Future research should focus on mixed-methods implementation science seeking to understand how best to translate evidence-based integrated ECD packages into effective intersectoral policies and programs on a large scale. In addition to health and nutrition, these programs need to consider and include responsive parenting (including responsive feeding), learning stimulation, education, and social protection. Future studies should also address if and how childhood obesity affects human physical, socioemotional, and cognitive development.

Nutritional status and social behavior in preschool children: the mediating effects of neurocognitive functioning

Early malnutritional status has been associated with reduced cognitive ability in childhood. However, there are almost no studies on the effect of malnutrition on positive social behavior, and no tests of possible mediating mechanisms. This study tests the hypothesis that poor nutritional status is associated with impaired social functioning in childhood, and that neurocognitive ability mediates this relationship. We assessed 1553 male and female 3-year-olds from a birth cohort on measures of malnutrition, social behavior and verbal and spatial neurocognitive functions. Children with indicators of malnutrition showed impaired social behavior (p < .0001) as compared with children in the control group with adequate nutritional status. These associations even persisted after controlling for social adversity and parental education. Findings were not moderated by gender or ethnicity, and there was no interaction effect with parental education. A dose-response relationship was observed between degree of malnutrition and degree of social behavior, with increased malnutrition associated with more impaired social behavior. Neurocognitive ability was found to mediate the nutrition-social behavior relationship. The mediation effect of neurocognitive functioning suggests that poor nutrition negatively impacts brain areas that play important roles in developing positive social behavior. Findings suggest that reducing poor nutrition, alternatively promoting good nutrition, may help promote positive social behavior in early childhood during a critical period for social and neurocognitive development, with implications for improving positive health in adulthood.