Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED

Benjamin J.J. McCormick; Stephanie A. Richard; Laura E. Caulfield; Laura L. Pendergast; Jessica C. Seidman; Beena Koshy; Reeba Roshan; Rita Shrestha; Erling Svensen; Ladislaus Blacy; Zeba Rasmussen; Angelina Maphula; Rebecca Scharf; Baitun Nahar; Sayma Haque; Muneera Rasheed; Reinaldo B. Oria; Elizabeth T. Rogawski; Laura E. Murray-Kolb; Angel Mendez Acosta; Rosa Rios De Burga; Cesar Banda Chavez; Julian Torres Flores; Maribel Paredes Olotegui; Silvia Rengifo Pinedo; Mery Siguas Salas; Dixner Rengifo Trigoso; Angel Orbe Vasquez; Imran Ahmed; Didar Alam; Asad Ali; Zulfiqar A. Bhutta; Shahida Qureshi; Sajid Soofi; Ali Turab; Anita K.M. Zaidi; Ladaporn Bodhidatta; Carl J. Mason; Sudhir Babji; Anuradha Bose; Ajila T. George; Dinesh Hariraju; M. Steffi Jennifer; Sushil John; Shiny Kaki; Gagandeep Kang; Priyadarshani Karunakaran; Robin P. Lazarus; Jayaprakash Muliyil; Mohan Venkata Raghava; Sophy Raju; Anup Ramachandran; Rakhi Ramadas; Karthikeyan Ramanujam; Srujan L. Sharma; Shanmuga E. Sundaram; Rahul J. Thomas; William K. Pan; Ramya Ambikapathi; J. Daniel Carreon; Vivek Charu; Viyada Doan; Jhanelle Graham; Christel Hoest; Stacey Knobler; Dennis R. Lang; Monica McGrath; Mark A. Miller; Archana Mohale; Gaurvika Nayyar; Stephanie Psaki; Vivian Wang; Rebecca Blank; Michael Gottlieb; Karen H. Tountas; Caroline Amour; Eliwaza Bayyo; Estomih R. Mduma; Regisiana Mvungi; Rosemary Nshama; John Pascal; Buliga Mujaga Swema; Ladislaus Yarrot; Tahmeed Ahmed; A. M.Shamsir Ahmed; Rashidul Haque; Iqbal Hossain; Munirul Islam; Mustafa Mahfuz; Dinesh Mondal; Fahmida Tofail; Ram Krishna Chandyo; Prakash Sunder Shrestha; Manjeswori Ulak; Aubrey Bauck; Robert E. Black; William Checkley; Margaret Kosek; Gwenyth O Lee; Kerry Schulze; Pablo Penataro Yori; A. Catharine Ross; Barbara Schaefer; Suzanne Simons; Samuel P. Scott; Cláudia B. Abreu; Hilda Costa; Alessandra Di Moura; José Quirino Filho; Alexandre Havt; Álvaro M. Leite; Aldo A.M. Lima; Noélia L. Lima; Ila F. Lima; Bruna L.L. Maciel; Pedro H.Q.S. Medeiros; Milena Moraes; Francisco S. Mota; Josiane Quetz; Alberto M. Soares; Rosa M.S. Mota; Crystal L. Patil; Pascal Bessong; Cloupas Mahopo; Emanuel Nyathi; Amidou Samie; Leah Barrett; Rebecca Dillingham; Jean Gratz; Richard L. Guerrant; Eric Houpt; William A. Petri; James Platts-Mills; Binob Shrestha; Sanjaya Kumar Shrestha; Tor Strand

doi:10.1093/jn/nxz055

Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED

Benjamin J.J. McCormick, Stephanie A. Richard, Laura E. Caulfield, Laura L. Pendergast, Jessica C. Seidman, Beena Koshy, Reeba Roshan, Rita Shrestha, Erling Svensen, Ladislaus Blacy, Zeba Rasmussen, Angelina Maphula, Rebecca Scharf, Baitun Nahar, Sayma Haque, Muneera Rasheed, Reinaldo B. Oria, Elizabeth T. Rogawski, Laura E. Murray-Kolb, Angel Mendez AcostaRosa Rios De Burga, Cesar Banda Chavez, Julian Torres Flores, Maribel Paredes Olotegui, Silvia Rengifo Pinedo, Mery Siguas Salas, Dixner Rengifo Trigoso, Angel Orbe Vasquez, Imran Ahmed, Didar Alam, Asad Ali, Zulfiqar A. Bhutta, Shahida Qureshi, Sajid Soofi, Ali Turab, Anita K.M. Zaidi, Ladaporn Bodhidatta, Carl J. Mason, Sudhir Babji, Anuradha Bose, Ajila T. George, Dinesh Hariraju, M. Steffi Jennifer, Sushil John, Shiny Kaki, Gagandeep Kang, Priyadarshani Karunakaran, Robin P. Lazarus, Jayaprakash Muliyil, Mohan Venkata Raghava, Sophy Raju, Anup Ramachandran, Rakhi Ramadas, Karthikeyan Ramanujam, Srujan L. Sharma, Shanmuga E. Sundaram, Rahul J. Thomas, William K. Pan, Ramya Ambikapathi, J. Daniel Carreon, Vivek Charu, Viyada Doan, Jhanelle Graham, Christel Hoest, Stacey Knobler, Dennis R. Lang, Monica McGrath, Mark A. Miller, Archana Mohale, Gaurvika Nayyar, Stephanie Psaki, Vivian Wang, Rebecca Blank, Michael Gottlieb, Karen H. Tountas, Caroline Amour, Eliwaza Bayyo, Estomih R. Mduma, Regisiana Mvungi, Rosemary Nshama, John Pascal, Buliga Mujaga Swema, Ladislaus Yarrot, Tahmeed Ahmed, A. M.Shamsir Ahmed, Rashidul Haque, Iqbal Hossain, Munirul Islam, Mustafa Mahfuz, Dinesh Mondal, Fahmida Tofail, Ram Krishna Chandyo, Prakash Sunder Shrestha, Manjeswori Ulak, Aubrey Bauck, Robert E. Black, William Checkley, Margaret Kosek, Gwenyth O Lee, Kerry Schulze, Pablo Penataro Yori, A. Catharine Ross, Barbara Schaefer, Suzanne Simons, Samuel P. Scott, Cláudia B. Abreu, Hilda Costa, Alessandra Di Moura, José Quirino Filho, Alexandre Havt, Álvaro M. Leite, Aldo A.M. Lima, Noélia L. Lima, Ila F. Lima, Bruna L.L. Maciel, Pedro H.Q.S. Medeiros, Milena Moraes, Francisco S. Mota, Josiane Quetz, Alberto M. Soares, Rosa M.S. Mota, Crystal L. Patil, Pascal Bessong, Cloupas Mahopo, Emanuel Nyathi, Amidou Samie, Leah Barrett, Rebecca Dillingham, Jean Gratz, Richard L. Guerrant, Eric Houpt, William A. Petri, James Platts-Mills, Binob Shrestha, Sanjaya Kumar Shrestha, Tor Strand

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results: Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (β: -1.81, 95% CI: -2.75, -0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions: A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.

Original language	English (US)
Pages (from-to)	1460-1469
Number of pages	10
Journal	Journal of Nutrition
Volume	149
Issue number	8
DOIs	https://doi.org/10.1093/jn/nxz055
State	Published - Aug 1 2019

Keywords

cognitive development
diarrhea
dietary intake
home environment
illness
micronutrients

ASJC Scopus subject areas

Medicine (miscellaneous)
Nutrition and Dietetics

Access to Document

10.1093/jn/nxz055

Cite this

McCormick, B. J. J., Richard, S. A., Caulfield, L. E., Pendergast, L. L., Seidman, J. C., Koshy, B., Roshan, R., Shrestha, R., Svensen, E., Blacy, L., Rasmussen, Z., Maphula, A., Scharf, R., Nahar, B., Haque, S., Rasheed, M., Oria, R. B., Rogawski, E. T., Murray-Kolb, L. E., ... Strand, T. (2019). Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED. Journal of Nutrition, 149(8), 1460-1469. https://doi.org/10.1093/jn/nxz055

Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED. / McCormick, Benjamin J.J.; Richard, Stephanie A.; Caulfield, Laura E. et al.
In: Journal of Nutrition, Vol. 149, No. 8, 01.08.2019, p. 1460-1469.

Research output: Contribution to journal › Article › peer-review

McCormick, BJJ, Richard, SA, Caulfield, LE, Pendergast, LL, Seidman, JC, Koshy, B, Roshan, R, Shrestha, R, Svensen, E, Blacy, L, Rasmussen, Z, Maphula, A, Scharf, R, Nahar, B, Haque, S, Rasheed, M, Oria, RB, Rogawski, ET, Murray-Kolb, LE, Acosta, AM, De Burga, RR, Chavez, CB, Flores, JT, Olotegui, MP, Pinedo, SR, Salas, MS, Trigoso, DR, Vasquez, AO, Ahmed, I, Alam, D, Ali, A, Bhutta, ZA, Qureshi, S, Soofi, S, Turab, A, Zaidi, AKM, Bodhidatta, L, Mason, CJ, Babji, S, Bose, A, George, AT, Hariraju, D, Jennifer, MS, John, S, Kaki, S, Kang, G, Karunakaran, P, Lazarus, RP, Muliyil, J, Raghava, MV, Raju, S, Ramachandran, A, Ramadas, R, Ramanujam, K, Sharma, SL, Sundaram, SE, Thomas, RJ, Pan, WK, Ambikapathi, R, Carreon, JD, Charu, V, Doan, V, Graham, J, Hoest, C, Knobler, S, Lang, DR, McGrath, M, Miller, MA, Mohale, A, Nayyar, G, Psaki, S, Wang, V, Blank, R, Gottlieb, M, Tountas, KH, Amour, C, Bayyo, E, Mduma, ER, Mvungi, R, Nshama, R, Pascal, J, Swema, BM, Yarrot, L, Ahmed, T, Ahmed, AMS, Haque, R, Hossain, I, Islam, M, Mahfuz, M, Mondal, D, Tofail, F, Chandyo, RK, Shrestha, PS, Ulak, M, Bauck, A, Black, RE , Checkley, W, Kosek, M, Lee, GO, Schulze, K, Penataro Yori, P, Ross, AC, Schaefer, B, Simons, S, Scott, SP, Abreu, CB, Costa, H, Moura, AD, Filho, JQ, Havt, A, Leite, ÁM, Lima, AAM, Lima, NL, Lima, IF, Maciel, BLL, Medeiros, PHQS, Moraes, M, Mota, FS, Quetz, J, Soares, AM, Mota, RMS, Patil, CL, Bessong, P, Mahopo, C, Nyathi, E, Samie, A, Barrett, L, Dillingham, R, Gratz, J, Guerrant, RL, Houpt, E, Petri, WA, Platts-Mills, J, Shrestha, B, Shrestha, SK & Strand, T 2019, 'Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED', Journal of Nutrition, vol. 149, no. 8, pp. 1460-1469. https://doi.org/10.1093/jn/nxz055

@article{815875de93674b0ab6775a4fabc5d47e,

title = "Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED",

abstract = "Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results: Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (β: -1.81, 95% CI: -2.75, -0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions: A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.",

keywords = "cognitive development, diarrhea, dietary intake, home environment, illness, micronutrients",

author = "McCormick, {Benjamin J.J.} and Richard, {Stephanie A.} and Caulfield, {Laura E.} and Pendergast, {Laura L.} and Seidman, {Jessica C.} and Beena Koshy and Reeba Roshan and Rita Shrestha and Erling Svensen and Ladislaus Blacy and Zeba Rasmussen and Angelina Maphula and Rebecca Scharf and Baitun Nahar and Sayma Haque and Muneera Rasheed and Oria, {Reinaldo B.} and Rogawski, {Elizabeth T.} and Murray-Kolb, {Laura E.} and Acosta, {Angel Mendez} and {De Burga}, {Rosa Rios} and Chavez, {Cesar Banda} and Flores, {Julian Torres} and Olotegui, {Maribel Paredes} and Pinedo, {Silvia Rengifo} and Salas, {Mery Siguas} and Trigoso, {Dixner Rengifo} and Vasquez, {Angel Orbe} and Imran Ahmed and Didar Alam and Asad Ali and Bhutta, {Zulfiqar A.} and Shahida Qureshi and Sajid Soofi and Ali Turab and Zaidi, {Anita K.M.} and Ladaporn Bodhidatta and Mason, {Carl J.} and Sudhir Babji and Anuradha Bose and George, {Ajila T.} and Dinesh Hariraju and Jennifer, {M. Steffi} and Sushil John and Shiny Kaki and Gagandeep Kang and Priyadarshani Karunakaran and Lazarus, {Robin P.} and Jayaprakash Muliyil and Raghava, {Mohan Venkata} and Sophy Raju and Anup Ramachandran and Rakhi Ramadas and Karthikeyan Ramanujam and Sharma, {Srujan L.} and Sundaram, {Shanmuga E.} and Thomas, {Rahul J.} and Pan, {William K.} and Ramya Ambikapathi and Carreon, {J. Daniel} and Vivek Charu and Viyada Doan and Jhanelle Graham and Christel Hoest and Stacey Knobler and Lang, {Dennis R.} and Monica McGrath and Miller, {Mark A.} and Archana Mohale and Gaurvika Nayyar and Stephanie Psaki and Vivian Wang and Rebecca Blank and Michael Gottlieb and Tountas, {Karen H.} and Caroline Amour and Eliwaza Bayyo and Mduma, {Estomih R.} and Regisiana Mvungi and Rosemary Nshama and John Pascal and Swema, {Buliga Mujaga} and Ladislaus Yarrot and Tahmeed Ahmed and Ahmed, {A. M.Shamsir} and Rashidul Haque and Iqbal Hossain and Munirul Islam and Mustafa Mahfuz and Dinesh Mondal and Fahmida Tofail and Chandyo, {Ram Krishna} and Shrestha, {Prakash Sunder} and Manjeswori Ulak and Aubrey Bauck and Black, {Robert E.} and William Checkley and Margaret Kosek and Lee, {Gwenyth O} and Kerry Schulze and {Penataro Yori}, Pablo and Ross, {A. Catharine} and Barbara Schaefer and Suzanne Simons and Scott, {Samuel P.} and Abreu, {Cl{\'a}udia B.} and Hilda Costa and Moura, {Alessandra Di} and Filho, {Jos{\'e} Quirino} and Alexandre Havt and Leite, {{\'A}lvaro M.} and Lima, {Aldo A.M.} and Lima, {No{\'e}lia L.} and Lima, {Ila F.} and Maciel, {Bruna L.L.} and Medeiros, {Pedro H.Q.S.} and Milena Moraes and Mota, {Francisco S.} and Josiane Quetz and Soares, {Alberto M.} and Mota, {Rosa M.S.} and Patil, {Crystal L.} and Pascal Bessong and Cloupas Mahopo and Emanuel Nyathi and Amidou Samie and Leah Barrett and Rebecca Dillingham and Jean Gratz and Guerrant, {Richard L.} and Eric Houpt and Petri, {William A.} and James Platts-Mills and Binob Shrestha and Shrestha, {Sanjaya Kumar} and Tor Strand",

note = "Funding Information: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the National Institutes of Health/Fogarty International Center. This work was also supported by the Fogarty International Center, National Institutes of Health (D43-TW009359 to ETR). Author disclosures: BJJM, SAR, LEC, LLP, JCS, BK, RR, RS, ES, LB, ZR, AM, RS, BN, SH, MR, RO, ETR, and LEM-K, no conflicts of interest. Supplemental Tables 1–5 and Supplemental Figures 1–3 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn/. Address correspondence to LEM-K (e-mail: lem118@psu.edu). Abbreviations used: HOME, Home Observation for Measurement of the Environment inventory; MAL-ED, The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project; TfR, transferrin receptor; WPPSI, Wechsler Preschool Primary Scales of Intelligence. Publisher Copyright: {\textcopyright} Copyright American Society for Nutrition 2019.",

year = "2019",

month = aug,

day = "1",

doi = "10.1093/jn/nxz055",

language = "English (US)",

volume = "149",

pages = "1460--1469",

journal = "Journal of Nutrition",

issn = "0022-3166",

publisher = "American Society for Nutrition",

number = "8",

}

TY - JOUR

T1 - Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years

T2 - Results from MAL-ED

AU - McCormick, Benjamin J.J.

AU - Richard, Stephanie A.

AU - Caulfield, Laura E.

AU - Pendergast, Laura L.

AU - Seidman, Jessica C.

AU - Koshy, Beena

AU - Roshan, Reeba

AU - Shrestha, Rita

AU - Svensen, Erling

AU - Blacy, Ladislaus

AU - Rasmussen, Zeba

AU - Maphula, Angelina

AU - Scharf, Rebecca

AU - Nahar, Baitun

AU - Haque, Sayma

AU - Rasheed, Muneera

AU - Oria, Reinaldo B.

AU - Rogawski, Elizabeth T.

AU - Murray-Kolb, Laura E.

AU - Acosta, Angel Mendez

AU - De Burga, Rosa Rios

AU - Chavez, Cesar Banda

AU - Flores, Julian Torres

AU - Olotegui, Maribel Paredes

AU - Pinedo, Silvia Rengifo

AU - Salas, Mery Siguas

AU - Trigoso, Dixner Rengifo

AU - Vasquez, Angel Orbe

AU - Ahmed, Imran

AU - Alam, Didar

AU - Ali, Asad

AU - Bhutta, Zulfiqar A.

AU - Qureshi, Shahida

AU - Soofi, Sajid

AU - Turab, Ali

AU - Zaidi, Anita K.M.

AU - Bodhidatta, Ladaporn

AU - Mason, Carl J.

AU - Babji, Sudhir

AU - Bose, Anuradha

AU - George, Ajila T.

AU - Hariraju, Dinesh

AU - Jennifer, M. Steffi

AU - John, Sushil

AU - Kaki, Shiny

AU - Kang, Gagandeep

AU - Karunakaran, Priyadarshani

AU - Lazarus, Robin P.

AU - Muliyil, Jayaprakash

AU - Raghava, Mohan Venkata

AU - Raju, Sophy

AU - Ramachandran, Anup

AU - Ramadas, Rakhi

AU - Ramanujam, Karthikeyan

AU - Sharma, Srujan L.

AU - Sundaram, Shanmuga E.

AU - Thomas, Rahul J.

AU - Pan, William K.

AU - Ambikapathi, Ramya

AU - Carreon, J. Daniel

AU - Charu, Vivek

AU - Doan, Viyada

AU - Graham, Jhanelle

AU - Hoest, Christel

AU - Knobler, Stacey

AU - Lang, Dennis R.

AU - McGrath, Monica

AU - Miller, Mark A.

AU - Mohale, Archana

AU - Nayyar, Gaurvika

AU - Psaki, Stephanie

AU - Wang, Vivian

AU - Blank, Rebecca

AU - Gottlieb, Michael

AU - Tountas, Karen H.

AU - Amour, Caroline

AU - Bayyo, Eliwaza

AU - Mduma, Estomih R.

AU - Mvungi, Regisiana

AU - Nshama, Rosemary

AU - Pascal, John

AU - Swema, Buliga Mujaga

AU - Yarrot, Ladislaus

AU - Ahmed, Tahmeed

AU - Ahmed, A. M.Shamsir

AU - Haque, Rashidul

AU - Hossain, Iqbal

AU - Islam, Munirul

AU - Mahfuz, Mustafa

AU - Mondal, Dinesh

AU - Tofail, Fahmida

AU - Chandyo, Ram Krishna

AU - Shrestha, Prakash Sunder

AU - Ulak, Manjeswori

AU - Bauck, Aubrey

AU - Black, Robert E.

AU - Checkley, William

AU - Kosek, Margaret

AU - Lee, Gwenyth O

AU - Schulze, Kerry

AU - Penataro Yori, Pablo

AU - Ross, A. Catharine

AU - Schaefer, Barbara

AU - Simons, Suzanne

AU - Scott, Samuel P.

AU - Abreu, Cláudia B.

AU - Costa, Hilda

AU - Moura, Alessandra Di

AU - Filho, José Quirino

AU - Havt, Alexandre

AU - Leite, Álvaro M.

AU - Lima, Aldo A.M.

AU - Lima, Noélia L.

AU - Lima, Ila F.

AU - Maciel, Bruna L.L.

AU - Medeiros, Pedro H.Q.S.

AU - Moraes, Milena

AU - Mota, Francisco S.

AU - Quetz, Josiane

AU - Soares, Alberto M.

AU - Mota, Rosa M.S.

AU - Patil, Crystal L.

AU - Bessong, Pascal

AU - Mahopo, Cloupas

AU - Nyathi, Emanuel

AU - Samie, Amidou

AU - Barrett, Leah

AU - Dillingham, Rebecca

AU - Gratz, Jean

AU - Guerrant, Richard L.

AU - Houpt, Eric

AU - Petri, William A.

AU - Platts-Mills, James

AU - Shrestha, Binob

AU - Shrestha, Sanjaya Kumar

AU - Strand, Tor

N1 - Funding Information: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the National Institutes of Health/Fogarty International Center. This work was also supported by the Fogarty International Center, National Institutes of Health (D43-TW009359 to ETR). Author disclosures: BJJM, SAR, LEC, LLP, JCS, BK, RR, RS, ES, LB, ZR, AM, RS, BN, SH, MR, RO, ETR, and LEM-K, no conflicts of interest. Supplemental Tables 1–5 and Supplemental Figures 1–3 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn/. Address correspondence to LEM-K (e-mail: lem118@psu.edu). Abbreviations used: HOME, Home Observation for Measurement of the Environment inventory; MAL-ED, The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project; TfR, transferrin receptor; WPPSI, Wechsler Preschool Primary Scales of Intelligence. Publisher Copyright: © Copyright American Society for Nutrition 2019.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results: Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (β: -1.81, 95% CI: -2.75, -0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions: A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.

AB - Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results: Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (β: -1.81, 95% CI: -2.75, -0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions: A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.

KW - cognitive development

KW - diarrhea

KW - dietary intake

KW - home environment

KW - illness

KW - micronutrients

UR - http://www.scopus.com/inward/record.url?scp=85071055897&partnerID=8YFLogxK

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U2 - 10.1093/jn/nxz055

DO - 10.1093/jn/nxz055

M3 - Article

C2 - 31162601

AN - SCOPUS:85071055897

SN - 0022-3166

VL - 149

SP - 1460

EP - 1469

JO - Journal of Nutrition

JF - Journal of Nutrition

IS - 8

ER -

Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years: Results from MAL-ED

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