The association of early linear growth and haemoglobin concentration with later cognitive, motor, and social–emotional development at preschool age in Ghana

Abstract

It is important to identify the periods during childhood when exposure to environmental risk factors results in long‐term neurodevelopmental deficits. Stunting and anaemia may be sensitive indicators of exposure to such risks. In a prospective cohort enrolled before birth, we investigated the association of developmental scores at 4–6 years with (a) birth length and linear growth during three postnatal periods and (2) haemoglobin (Hb) concentration at three time points. Children were participants in a follow‐up study of a randomized controlled trial of nutritional supplementation in Ghana. At 4–6 years, cognitive, motor, and social–emotional developments were assessed using standard tests adapted for this population. We estimated the associations of length‐for‐age z‐score (LAZ) at birth and postnatal linear growth (n = 710) and Hb (n = 617) with developmental scores in regression models, using multistage least squares analysis to calculate uncorrelated residuals for postnatal growth. Cognitive development at 4–6 years was significantly associated with LAZ at birth (β = 0.12, 95% CI = 0.05, 0.19), ΔLAZ from 6 to 18 months (β = 0.16, 95% CI = 0.04, 0.28), and Hb at 18 months (β = 0.13, 95% CI = 0.06, 0.20), but not with ΔLAZ during 0–6 months, ΔLAZ from 18 months to 4–6 years, Hb at 6 months, or Hb at 4–6 years. No evidence of associations with motor or social–emotional development were found. These results suggest that in similar contexts, the earlier periods prior to birth and up to 18 months are more sensitive to risk factors for long‐term cognitive development associated with LAZ and Hb compared with later childhood. This may inform the optimal timing of interventions targeting improved cognitive development.

Nutrition, growth, and other factors associated with early cognitive and motor development in Sub‐Saharan Africa: a scoping review

“…Cognitive development and linear growth at age 4–6 years was also reported by Ocansey et al . ( 25 ) to be significantly associated with haemoglobin concentration at 18 months but, unlike Mireku et al . ( 23 ) , Ocansey et al .…”

“…( 23 ) , Ocansey et al . ( 25 ) found no association with motor development. A randomised control trial (RCT) exploring prenatal supplementation with vitamin A and zinc ( 21 ) reported no developmental benefits in children of women consuming the supplement.…”

“…Many studies evaluated the influence of children’s physical health on their early cognitive and motor development. Although some studies focused on stunting and growth ( 10,14,21‐25 ) , others focused more specifically on anthropometry at birth ( 31‐34 ) . Most studies found a strong relationship between restricted physical growth and poor early cognitive and motor outcomes.…”

“…Anthropometry at birth was explored in relation to long‐term early child development. Length‐for‐age scores at birth and at 6 and 18 months were associated with cognitive but not motor development in children aged 4–6 years in Ghana ( 25 ) . High‐fat mass in the first 48 h of birth predicted high global developmental scores ( 31 ) .…”

Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study

“…The association between persistent stunting and cognitive development has been demonstrated [15]. A recent meta-analysis of 29 LMICs has established a positive association between linear growth and cognitive development in the first 2 years of life [16], but the meta-analysis could not integrate environmental, educational, and follow-up data to describe the relationship between stunting and cognitive impairment.…”