title: Household food group expenditure patterns are associated with child anthropometry at ages 5, 8 and 12 years in Ethiopia, India, Peru and Vietnam.
abstract: Population-level analysis of dietary influences on nutritional status is challenging in part due to limitations in dietary intake data. Household expenditure surveys, covering recent household expenditures and including key food groups, are routinely conducted in low- and middle-income countries. These data may help identify patterns of food expenditure that relate to child growth.
  
  
  
  We investigated the relationship between household food expenditures and child growth using factor analysis.
  
  
  
  We used data on 6993 children from Ethiopia, India, Peru and Vietnam at ages 5, 8 and 12y from the Young Lives cohort. We compared associations between household food expenditures and child growth (height-for-age z scores, HAZ; body mass index-for-age z scores, BMI-Z) using total household food expenditures and the "household food group expenditure index" (HFGEI) extracted from household expenditures with factor analysis on the seven food groups in the child dietary diversity scale, controlling for total food expenditures, child dietary diversity, data collection round, rural/urban residence and child sex. We used the HFGEI to capture households' allocations of their finances across food groups in the context of local food pricing, availability and pReferences RESULTS: The HFGEI was associated with significant increases in child HAZ in Ethiopia (0.07), India (0.14), and Vietnam (0.07) after adjusting for all control variables. Total food expenditures remained significantly associated with increases in BMI-Z for India (0.15), Peru (0.11) and Vietnam (0.06) after adjusting for study round, HFGEI, dietary diversity, rural residence, and whether the child was female. Dietary diversity was inversely associated with BMI-Z in India and Peru. Mean dietary diversity increased from age 5y to 8y and decreased from age 8y to 12y in all countries.
  
  
  
  Household food expenditure data provide insights into household food purchasing patterns that significantly predict HAZ and BMI-Z. Including food expenditure patterns data in analyses may yield important information about child nutritional status and linear growth.
authors.affiliation: Department of Epidemiology of Microbial Disease, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520-8034, USA. Electronic address: debbie.humphries@yale.edu.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Humphries
authors.affiliation: Department of Global Health, Boston University, Boston, MA, USA. Electronic address: kirkdearden@imaworldhealth.org.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Dearden
authors.affiliation: Department of Health Science, Brigham Young University, Provo, UT, USA. Electronic address: benjamin_crookston@byu.edu.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Crookston
authors.affiliation: Department of Economics, Addis Ababa University, Addis Ababa, Ethiopia. Electronic address: tassew.woldehanna@gmail.com.
authors.forename: Tassew
authors.initials: T
authors.lastname: Woldehanna
authors.affiliation: Instituto de Investigación Nutricional, Lima, Peru. Electronic address: mpenny@iin.sld.pe.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Penny
authors.affiliation: Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: jbehrman@econ.upenn.edu.
authors.forename: Jere R
authors.initials: JR
authors.lastname: Behrman
mesh_terms: D000886:Anthropometry; D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D005002:Ethiopia; D005518:Food Preferences / Q000145:classification*; D006801:Humans; D007194:India; D010568:Peru; D012424:Rural Population; D014744:Vietnam
keywords: Child growth; Household food expenditures; Household food purchasing patterns; Longitudinal cohort study; Weight gain