title: Annual Research Review: Improved nutrition--pathway to resilience.
abstract: BACKGROUND
  Early child nutritional deficiencies are prevalent in low- and middle-countries with consequences linked not only to poor survival and growth, but also to poor development outcomes. Children in disadvantaged communities face multiple risks for nutritional deficiencies, yet some children may be less susceptible or may recover more quickly from malnutrition. A greater understanding is needed about factors which moderate the effects of nutrition-related risks and foster resilience to protect against or ameliorate poor development outcomes.
  
  
  METHODS
  A literature review was undertaken from August to December 2011 and updated in August 2012. Key word searches using terms Nutrition, Malnutrition, Child Development, Responsive Care, Stimulation, Low and Middle Income Countries and Resilience were undertaken using PubMed and Psychinfo.
  
  
  RESULTS
  Dietary adequacy is critical for growth and development, but current evidence indicates that nutrition supplementation alone is insufficient to foster resilience to protect against, mitigate, and recover from nutritional threats and to promote healthy development. The combination of nutrition interventions with stimulation and responsive care is necessary. Combined nutrition and psychosocial stimulation approaches can potentially work effectively together to promote protective factors and mitigate risks for poor cognitive, motor, social, and affective functioning helping children to adapt in times of adversity. However, there are gaps in our existing knowledge to combine nutrition and psychosocial stimulation interventions effectively and promote these interventions at scale.
  
  
  CONCLUSIONS
  Research needs to address barriers at the level of family, community, programme, and policy which have prevented thus far the uptake of combined nutrition and psychosocial intervention strategies. Further investigations are needed on how to provide support to caregivers, enabling them to implement appropriate care for feeding and stimulation. Finally, the effect of combined interventions on pathways of care and protective mediators that foster resilience need to be better understood to determine focus areas for content of combined intervention curricula which help families in high-risk settings.
authors.affiliation: Department of Paediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan. yousafzai@aku.edu
authors.forename: Aisha K
authors.initials: AK
authors.lastname: Yousafzai
authors.forename: Muneera A
authors.initials: MA
authors.lastname: Rasheed
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D002648:Child; D015362:Child Nutrition Disorders / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D002675:Child, Preschool; D003906:Developing Countries; D002658:Developmental Disabilities / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D019587:Dietary Supplements; D018479:Early Intervention, Educational; D004493:Education; D005260:Female; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011247:Pregnancy; D011640:Public Policy; D055500:Resilience, Psychological; D012917:Social Adjustment; D012931:Social Environment; D012944:Social Support