title: Head growth of undernourished children in rural Nepal: association with demographics, health and diet.
abstract: Brain development in early childhood is a key determinant of later cognition, social achievement and educational success. Head circumference (HC) measurements are a simple method to assess brain growth, yet reports of these measurements are uncommon in nutritional surveys of undernourished children.
  
  
  
  To evaluate HC measurements in a population of rural Nepali children and relate these measurements to demographics, health and diet.
  
  
  
  An observational study of head growth was nested within a longitudinal evaluation of a livestock-based agricultural intervention in rural Nepal. Between 538 and 689 children (aged 6 months to 8 years) were measured (height, weight, HC) at each of six survey visits. A total of 3652 HC measurements were obtained. Results were converted to Z-scores (WHO Anthro).
  
  
  
  Mean head circumference Z-scores (HCZ) diminished progressively over the first 4 years of life; a decline of 30% occurred between 3 and 4 years of age (-1.73 to -2.45, P < 0.0001). Overall, 56% of HCZ were <-2. Gender-adjusted HCZ (but not other measurements) were significantly lower for girls than boys [mean (SD) -2.31 (1.0) vs -1.99 (0.094), P < 0.0001]; girls more often had microcephaly (61% vs 50%, P < 0.0001). For children <3 years of age, HCZ were better in those who had eaten two or more animal-source foods (ASFs) within the previous 24 h [-1.69 (.05) vs -2.08 (0.10), P = 0.001] than in those who had eaten none or only one; HCZ correlated with the number of ASFs consumed (P < 0.001). Regression analyses demonstrated that the main determinants of HCZ were age, weight-for-age Z-scores (WAZ) and gender; 43% of the variance in HCZ in younger children was explained by WAZ and ASF consumption.
  
  
  
  HCs reflect brain size in young children; brain size is linked to cognitive function. Poor head growth represents another facet of the 'silent emergency' of child undernutrition. Routine HCZ assessments may contribute to better understanding of the links between poverty and cognitive development.
authors.affiliation: a Department of Pediatrics , Tufts Medical Center , Boston , MA , USA.|b Friedman School of Nutrition Science and Policy, Tufts University , Boston , MA , USA.
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Miller
authors.affiliation: d Heifer Nepal , Kathmandu , Nepal.
authors.forename: Neena
authors.initials: N
authors.lastname: Joshi
authors.affiliation: c Heifer International , Little Rock , AR , USA.
authors.forename: Mahendra
authors.initials: M
authors.lastname: Lohani
authors.affiliation: e B. P. Koirala Institute of Health Sciences , Dharan , Nepal.
authors.forename: Rupa
authors.initials: R
authors.lastname: Singh
authors.affiliation: e B. P. Koirala Institute of Health Sciences , Dharan , Nepal.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bhatta
authors.affiliation: b Friedman School of Nutrition Science and Policy, Tufts University , Boston , MA , USA.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Rogers
authors.affiliation: b Friedman School of Nutrition Science and Policy, Tufts University , Boston , MA , USA.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Griffiths
authors.affiliation: b Friedman School of Nutrition Science and Policy, Tufts University , Boston , MA , USA.
authors.forename: Shibani
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: d Heifer Nepal , Kathmandu , Nepal.
authors.forename: Shubh
authors.initials: S
authors.lastname: Mahato
authors.affiliation: c Heifer International , Little Rock , AR , USA.
authors.forename: Padma
authors.initials: P
authors.lastname: Singh
authors.affiliation: b Friedman School of Nutrition Science and Policy, Tufts University , Boston , MA , USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Webb
mesh_terms: D000886:Anthropometry; D001921:Brain / Q000254:growth & development*; D002648:Child; D002657:Child Development; D000067576:Child Health / Q000706:statistics & numerical data*; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D003710:Demography; D004032:Diet / Q000706:statistics & numerical data*; D005247:Feeding Behavior; D005260:Female; D006257:Head / Q000254:growth & development*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009390:Nepal / Q000453:epidemiology; D009752:Nutritional Status; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Animal source foods; Brain growth; Head growth; Malnutrition; Microcephaly; Nepal; Undernutrition