title: Malnutrition and Its Determinants Are Associated with Suboptimal Cognitive, Communication, and Motor Development in Tanzanian Children.
abstract: BACKGROUND
  A large volume of literature has shown negative associations between stunting and child development; however, there is limited evidence for associations with milder forms of linear growth faltering and determinants of malnutrition in developing countries.
  
  
  OBJECTIVE
  The objective of this study was to assess the association between anthropometric growth indicators across their distribution and determinants of malnutrition with development of Tanzanian children.
  
  
  METHODS
  We used the Bayley Scales of Infant Development III to assess a cohort of 1036 Tanzanian children between 18 and 36 mo of age who were previously enrolled in a neonatal vitamin A trial. Linear regression models were used to assess standardized mean differences in child development for anthropometry z scores, along with pregnancy, delivery, and early childhood factors.
  
  
  RESULTS
  Height-for-age z score (HAZ) was linearly associated with cognitive, communication, and motor development z scores across the observed range in this population (all P values for linear relation < 0.05). Each unit increase in HAZ was associated with +0.09 (95% CI: 0.05, 0.13), +0.10 (95% CI: 0.07, 0.14), and +0.13 (95% CI: 0.09, 0.16) higher cognitive, communication, and motor development z scores, respectively. The relation of weight-for-height z score (WHZ) was nonlinear with only wasted children (WHZ <-2) experiencing deficits (P values for nonlinear relation < 0.05). Wasted children had -0.63 (95% CI: -0.97, -0.29), -0.32 (95% CI: -0.64, 0.01), and -0.54 (95% CI: -0.86, -0.23) z score deficits in cognitive, communication, and motor development z scores, respectively, relative to nonwasted children. Maternal stature and flush toilet use were associated with higher cognitive and motor z scores, whereas being born small for gestational age (SGA) was associated with a -0.16 (95% CI: -0.30, -0.01) z score deficit in cognition.
  
  
  CONCLUSIONS
  Mild to severe chronic malnutrition was associated with increasing developmental deficits in Tanzanian children, whereas only wasted children exhibited developmental delays during acute malnutrition. Interventions to reduce SGA, improve sanitation, and increase maternal stature may have positive effects on child development. This trial was registered with the Australian New Zealand Clinical Trials Registry as ACTRN12610000636055.
authors.affiliation: Departments of Global Health and Population, csudfeld@hsph.harvard.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Sudfeld
authors.affiliation: Center on the Developing Child, Schools of Education and Public Health, Harvard University, Cambridge, MA;
authors.forename: Dana Charles
authors.initials: DC
authors.lastname: McCoy
authors.affiliation: Departments of Global Health and Population.
authors.forename: Günther
authors.initials: G
authors.lastname: Fink
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania;
authors.forename: Alfa
authors.initials: A
authors.lastname: Muhihi
authors.affiliation: Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Neurology, Boston Children's Hospital, Boston, MA; and.
authors.forename: David C
authors.initials: DC
authors.lastname: Bellinger
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania;
authors.forename: Honorati
authors.initials: H
authors.lastname: Masanja
authors.affiliation: Departments of Global Health and Population.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Smith
authors.affiliation: Departments of Global Health and Population, Epidemiology.
authors.forename: Goodarz
authors.initials: G
authors.lastname: Danaei
authors.affiliation: Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, Departments of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Departments of Global Health and Population, Epidemiology, Nutrition, and.
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D000367:Age Factors; D000886:Anthropometry; D001827:Body Height / Q000502:physiology; D001835:Body Weight; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000209:etiology; D003142:Communication; D003147:Communication Disorders / Q000209:etiology; D004311:Double-Blind Method; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D007223:Infant; D007236:Infant, Small for Gestational Age; D016014:Linear Models; D044342:Malnutrition / Q000150:complications* / Q000503:physiopathology*; D000068097:Maternal Health; D009048:Motor Skills / Q000502:physiology*; D019957:Motor Skills Disorders / Q000209:etiology; D011446:Prospective Studies; D013636:Tanzania
keywords: body height; body weights and measures; child development; cognition; infant; intelligence; malnutrition; nutrition; psychomotor performance; sanitation