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Effect of maternal pre-pregnancy underweight and average gestational weight gain on physical growth and intellectual development of early school-aged children

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      Abstract

      The aim of this study was to assess the effect of low maternal weight at pre-pregnancy and the average gestational weight gain on undernourished children and their intellectual development. From October 2012 to September 2013, we followed 1744 offspring of women who participated in a trial conducted from 2002 to 2006. Pregnant women recruited in the original trial could receive three prenatal health checks for free, at which maternal weight and height were measured. WISC-IV was used to estimate the intellectual development of children. Weight and height of both pregnant women and children were measured by trained anthropometrists using standard procedures. Having low maternal weight at pre-pregnancy was associated with an increased risk of undernutrition amongst children (underweight: OR = 2.02, 95%CI: 1.14–3.56, thinness: OR = 2.79, 95%CI: 1.50–5.17) and a decrease in verbal comprehension index (−2.70 points, 95%CI: −4.95–0.44) of children. The effect of average gestational weight gain on occurrences of underweight children (OR = 0.08, 95%CI: 0.01–0.55) was also found. We identified the effect of maternal pre-pregnancy underweight on impairment of the separate intellectual domains (verbal comprehension index) and increasing occurrence of undernourished children. Average gestational weight gain was positively associated with a decreased prevalence of underweight children but not with the intellectual development of children in rural China.

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      Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India.

      Using data from India, we estimate the relationship between household wealth and children's school enrollment. We proxy wealth by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights. In Indian data this index is robust to the assets included, and produces internally coherent results. State-level results correspond well to independent data on per capita output and poverty. To validate the method and to show that the asset index predicts enrollments as accurately as expenditures, or more so, we use data sets from Indonesia, Pakistan, and Nepal that contain information on both expenditures and assets. The results show large, variable wealth gaps in children's enrollment across Indian states. On average a "rich" child is 31 percentage points more likely to be enrolled than a "poor" child, but this gap varies from only 4.6 percentage points in Kerala to 38.2 in Uttar Pradesh and 42.6 in Bihar.
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        Development of a WHO growth reference for school-aged children and adolescents

        OBJECTIVE: To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. METHODS: Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1-24 years) were merged with data from the under-fives growth standards' cross-sectional sample (18-71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0-5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. FINDINGS: The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). CONCLUSION: The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group.
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          Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study.

          Chronic malnutrition during infancy, marked by stunting, has been associated with poor cognitive function. We assessed the effect of stunting, diarrhoeal disease, and parasitic infections during infancy on cognitive function in late childhood. We followed up from birth to 2 years, a cohort of 239 Peruvian children for anthropometrics, stool samples, and diarrhoeal status. At 9 years of age, we assessed cognitive function in 143 (69%) with the full-scale intelligence quotient of the Wechsler intelligence scale for children-revised (WISC-R). Findings All findings were adjusted for socioeconomic status and schooling; in addition, findings related to diarrhoea prevalence, Giardia lamblia, and Cryptosporidium parvum were adjusted for severe stunting. During the first 2 years of life, 46 (32%) of 143 children were stunted. Children with severe stunting in the second year of life scored 10 points lower on the WISC-R test (95% CI 2.4--17.5) than children without severe stunting. Children with more than one episode of G lamblia per year scored 4.1 points (0.2--8.0) lower than children with one episode or fewer per year. Neither diarrhoea prevalence nor Cparvum infection was associated with WISC-R scores. Malnutrition in early childhood, indexed by stunting, and potentially G lamblia, are associated with poor cognitive function at age 9 years. If the observed associations are causal, then intervention programmes designed to prevent malnutrition and G lamblia early in life could lead to significant improvement in cognitive function of children in similar lower-income communities throughout the less-developed world.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 0599 1243, GRID grid.43169.39, Department of Epidemiology and Biostatistics, School of Public Health, , Xi’an Jiaotong University Health Science Center, ; Xi’an, China
            [2 ]Department of Health Information, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China
            [3 ]ISNI 0000 0004 1936 9764, GRID grid.48004.38, Department of Clinical Sciences, , Liverpool School of Tropical Medicine, Pembroke Place, ; Liverpool, United Kingdom
            [4 ]Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi’an, China
            [5 ]ISNI 0000 0001 0599 1243, GRID grid.43169.39, Key Laboratory of Environment and Genes Related to Diseases, , Xi’an Jiaotong University, ; Xi’an, China
            Contributors
            yh.paper_xjtu@aliyun.com
            Journal
            Sci Rep
            Sci Rep
            Scientific Reports
            Nature Publishing Group UK (London )
            2045-2322
            13 August 2018
            13 August 2018
            2018
            : 8
            30104682
            6089877
            30514
            10.1038/s41598-018-30514-6
            © The Author(s) 2018

            Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

            Funding
            Funded by: FundRef https://doi.org/10.13039/501100001809, National Natural Science Foundation of China (National Science Foundation of China);
            Award ID: 81230016
            Award ID: 81230016
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            Award ID: 81230016
            Award Recipient :
            Funded by: FundRef https://doi.org/10.13039/501100002858, China Postdoctoral Science Foundation;
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award ID: 2016M592804
            Award Recipient :
            Funded by: FundRef https://doi.org/10.13039/501100004602, Program for New Century Excellent Talents in University (Program for New Century Excellent Talents);
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award ID: NCET-11-0417
            Award Recipient :
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