Nutrition as an important mediator of the impact of background variables on outcome in middle childhood
Frontiers in Human Neuroscience
Department of Publications and Ethics, International Centre for Behavioural Studies, Nairobi, Kenya; Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Research and Training, International Centre for Behavioural Studies, Mombasa, Kenya; Case Western Reserve University, Cleveland, OH, United States; Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, United States; Department of Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands; Department of Cross-Cultural Psychology, Tilburg University, Tilburg, Netherlands; Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Department of Psychology, University of Sheffield, Sheffield, United Kingdom
Adequate nutrition is fundamental to the development of a child's full potential. However, the extent to which malnutrition affects developmental and cognitive outcomes in the midst of co-occurring risk factors remains largely understudied. We sought to establish if the effects of nutritional status varied according to diverse background characteristics as well as to compare the relative strength of the effects of poor nutritional status on language skills, motor abilities, and cognitive functioning at school age. This cross-sectional study was conducted among school-age boys and girls resident in Kilifi District in Kenya. We hypothesized that the effects of area of residence, school attendance, household wealth, age and gender on child outcomes are experienced directly and indirectly through child nutritional status. The use of structural equation modeling (SEM) allowed the disaggregation of the total effect of the explanatory variables into direct effects (effects that go directly from one variable to another) and indirect effects. Each of the models tested for the four child outcomes had a good fit. However, the effects on verbal memory apart from being weaker than for the other outcomes, were not mediated through nutritional status. School attendance was the most influential predictor of nutritional status and child outcomes. The estimated models demonstrated the continued importance of child nutritional status at school-age. © 2013 Kitsao-Wekulo, Holding, Taylor, Abubakar, Kvalsvig and Connolly.
age; article; child; childhood; cognition; cross-sectional study; demography; female; gender; human; human experiment; Kenya; language; male; motor performance; normal human; nutritional status; outcome assessment; school; school child; structural equation modeling; verbal memory