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Cited by 176Child Nutrition and Water AccessBirth, Development, and HealthPublic Health and Nutrition

Do effects of early life interventions on linear growth correspond to effects on neurobehavioural development? A systematic review and meta-analysis

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Prado, Elizabeth L, Larson, Leila M, Cox, Katherine, Bettencourt, Kory, Kubes, Julianne N, Shankar, Anuraj H·2019·The Lancet Global Health
DOI 10.1016/s2214-109x(19)30361-4
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Abstract

BACKGROUND: Faltering in linear growth and neurobehavioural development during early childhood are often assumed to have common causes because of their consistent association. This notion has contributed to a global focus on the promotion of nutrition during pregnancy and childhood to improve both conditions. Our aim was to assess whether effects of interventions on linear growth are associated with effects on developmental scores and to quantify these associations. METHODS: In this systematic review and meta-analysis, we included randomised trials done during pregnancy and in children aged 0-5 years that reported effects of any intervention on length-for-age or height-for-age Z scores (LAZ or HAZ) and on any of the following outcomes: motor, cognitive or mental, language, and social-emotional or behavioural development. We searched MEDLINE (Ovid), CINAHL (EBSCO), and PsycINFO (EBSCO) from database inception to June 25, 2019. Study-level data were extracted and, when required, authors were contacted for missing information. We calculated weighted meta-regression coefficients of the association between standardised effect sizes of interventions on LAZ or HAZ and developmental outcome scores and calculated pooled effect sizes for different types of intervention. FINDINGS: Of the 7207 studies identified, we included 75 studies with 122 comparisons between intervention and control groups and outcomes reported for 72 275 children. Across all interventions, effect sizes on LAZ or HAZ were significantly associated with effect sizes on social-emotional scores (β 0·23, 95% CI 0·05 to 0·41; p=0·02), but not on cognitive (0·18, -0·36 to 0·72; p=0·51), language (0·12, -0·07 to 0·31; p=0·21), or motor development scores (0·23, -0·05 to 0·50; p=0·11). In studies that provided nutritional supplements, we observed positive significant pooled effect sizes on all five outcomes of LAZ or HAZ (effect size 0·05, 95% CI 0·01-0·09; p=0·01; n=50), cognitive or mental (0·06, 0·03-0·10; p<0·01; n=38), language (0·08, 0·03-0·13; p=0·01; n=21), motor (0·08, 0·04-0·12; p<0·01; n=41), and social-emotional (0·07, 0·02-0·12; p=0·01; n=20) scores. The effect sizes of nutritional supplementation on LAZ or HAZ scores were significantly associated with effect sizes on cognitive (β 0·40, 95% CI 0·04-0·77; p=0·049) and motor (0·43, 0·11-0·75; p=0·01) scores. In the 14 interventions promoting responsive care and learning opportunities, the pooled effect size on LAZ or HAZ score was not significant (-0·01, 95% CI -0·07 to 0·05; p=0·74), but pooled effect sizes on cognitive, language, and motor scores were 4 to 5 times larger (range 0·38-0·48) than the pooled effect sizes of nutritional supplementation (0·05-0·08). INTERPRETATION: In nutritional supplementation interventions, improvements in linear growth were associated with small improvements in child development, whereas nurturing and stimulation interventions had significant effects on child development but no effects on linear growth. The determinants of linear growth and neurodevelopment are only partly shared. To nurture thriving individuals and communities, interventions should specifically target determinants of neurodevelopment and not simply linear growth. FUNDING: University of California Davis, US Department of Agriculture National Institute of Food and Agriculture.

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  • Parenting interventions that include components to directly enhance early child learning or strengthen parent-child relationships are more effective for improving early cognitive, language, motor, and socioemotional development.

    “recent evidence has revealed that parenting interventions that include components to directly enhance early child learning or strengthen parent–child relationships are more effective for improving early cognitive, language, motor, and socioemotional development [5–7].”

    From Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis (2021) · cites this paper as [7]

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Authors
Prado, E. L., Larson, L. M., Cox, K., Bettencourt, K., Kubes, J. N., & Shankar, A. H.
Affiliations
  • University of California, Davis (US)
  • The University of Melbourne (AU)
  • Emory University (US)
  • Eijkman Institute for Molecular Biology (ID)
Corresponding author
Prado, Elizabeth L
ORCID
Venue
The Lancet Global Health
Publisher
Elsevier BV
Published
2019-10
Volume
7
Issue
10
Pages
e1398-e1413
ISSN
2214-109X (ISSN-L)
DOI
10.1016/s2214-109x(19)30361-4
OpenAlex
W2974582045
Cited by
173
References
96
Citations by year
2026: 18 · 2025: 24 · 2024: 31 · 2023: 28 · 2022: 27 · 2021: 27 · 2020: 15 · 2019: 2
FWCI
2.51
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Global Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • University of California, Davis
  • National Institute of Food and Agriculture (CA-D-NTR-2493-H)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
Keywords
linear growth faltering, early-life interventions, length-for-age z-score, height-for-age z-score, social-emotional development, cognitive development, language development, motor development, mental health, dietary supplementation, prenatal nutrition, early childhood nutrition, child growth and development, meta-regression
MeSH terms
Child, Child Development, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Nutritional Status, Pregnancy, Early Intervention, Educational, Dietary Supplements

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