Early-life nutrition, child growth, and adult cognitive and socioemotional functioning in Guatemala Open Access

Abstract

Children that develop in safe and nurturing environments that provide adequate nutrition, psychosocial stimulation, and learning opportunities are better equipped to reach their full developmental potential. It is estimated that in low-and middle-income countries (LMICs), 43% of children under age five do not reach basic developmental milestones due to causes that are rooted in poverty. This dissertation uses extensive longitudinal data to explore long-term associations between early-life nutrition, psychosocial stimulation, and child growth on cognitive and socioemotional capacities in subjects 40 to 57 y of age who in early-childhood participated in a nutritional supplementation trial in eastern Guatemala. Specific aims were to 1) examine associations between exposure to nutritional supplementation in the first 1,000 days and adult executive function and socioemotional capacities, and identify mediators between enhanced early-life nutrition and adult socioemotional outcomes, 2) identify distinct height-for-age (HAZ) linear growth trajectories from birth through age 84 months and examine their predictors and associations with adult executive function and socioemotional capacities, and 3) determine the cross-sectional interrelationships between cognitive and socioemotional functioning in adulthood. Results indicated that exposure to nutritional supplementation in the first 1,000 days was positively associated with executive function and socioemotional capacities at ages 40 to 57 y (n=1,268). Mediation analysis showed stronger associations between psychosocial stimulation and cognitive abilities than between nutritional supplementation and cognitive abilities (n=1,640). Results from the second aim revealed that linear growth trajectories showed similar (parallel) slopes that were primarily distinguished as a matter of severity of linear growth faltering at birth (intercepts). Maternal height, socioeconomic status, and exposure to nutritional supplementation in the first 1,000 days were positively associated with membership to the high-HAZ linear growth trajectory. Linear regression models indicated a gradient of positive associations between HAZ trajectories and measures of cognitive ability and meaning and purpose at ages 40 to 57 y. Completed grades of schooling partially mediated the association between high-HAZ linear growth trajectory and scores on non-verbal fluid intelligence and working memory capacity. Lastly, the cross-sectional analysis indicated that executive function and non-verbal fluid intelligence at ages 40 to 57 y were strongly correlated with each other and weakly correlated with socioemotional functioning (n=1,268). Findings from this dissertation suggest that linear growth is a marker of early-life neurological development that remains intricately intertwined with both cognitive and socioemotional domains. Furthermore, results suggest that in populations in which undernutrition is prevalent, programs addressing both nutrition and psychosocial stimulation may produce greater long-term benefits in cognitive and socioemotional outcomes than nutritional supplementation alone. This study, together with several others conducted in LMICs, indicate the need to identify evidence-based and comprehensive intervention packages that integrate psychosocial stimulation and nutritional components in early childhood. 

Table of Contents

CHAPTER 1: Introduction........... ............................................................................................................. 1 

1.1 Research Aim 1 ................................................................................................................................... 5 

1.2 Research Aim 2 ................................................................................................................................... 5 

1.3 Research Aim 3 ................................................................................................................................... 6 

CHAPTER 2: Background ......................................................................................................................... 12 

2.1 A Life Course Approach to Adult Outcomes ....................................................................................... 12 

2.2 Early Brain Development .................................................................................................................... 13 

2.3 Stress and Early Brain Development.................................................................................................... 15 

2.4 Domains of Early Childhood Development ......................................................................................... 16 

2.5 Predictors of Child Developmental Potential ...................................................................................... 24 

2.6 Summary ............................................................................................................................................. 34 

2.7 References ........................................................................................................................................... 35 

CHAPTER 3: Methods ............................................................................................................................... 49 

3.1 Study Setting: The INCAP Longitudinal Study ................................................................................ ....49 

3.2 Data Sources ........................................................................................................................................ 50 

3.3 Training and Data Collection ............................................................................................................... 59 

3.4 Data Analysis ....................................................................................................................................... 60 

3.5 Summary .............................................................................................................................................. 66 

3.6 References ............................................................................................................................................ 68 

CHAPTER 4: Early-childhood nutritional supplementation and psychosocial stimulation influences on

cognition and socioemotional functioning in growth-stunted Guatemalan adults.................................... 71 

4.1 Abstract ................................................................................................................................................ 72 

4.2 Introduction .......................................................................................................................................... 74 

4.4 Methods ................................................................................................................................................ 78 

4.5 Results .................................................................................................................................................. 86 

4.6 Discussion ............................................................................................................................................. 88 

4.7 References ............................................................................................................................................. 93 

CHAPTER 5: Associations between height-for-age linear growth trajectories from birth to 7 years and adult

cognitive and socioemotional functioning in a Guatemalan cohort. ......................................................... 112 

5.1 Abstract ................................................................................................................................................ 113 

5.2 Introduction ......................................................................................................................................... 115 

5.3 Methods ............................................................................................................................................... 117 

5.5 Results .................................................................................................................................................. 124 

5.6 Discussion ............................................................................................................................................ 127 

5.7 References ............................................................................................................................................ 133 

CHAPTER 6: Cross-sectional interrelationships between cognitive and socio-emotional functioning in

Guatemalan adults ..................................................................................................................................... 158 

6.1 Abstract ................................................................................................................................................ 159 

6.2 Background ........................................................................................................................................... 160 

6.3 Methods ................................................................................................................................................ 162 

6.4 Results .................................................................................................................................................. 168 

6.5 Discussion ............................................................................................................................................. 170 

6.6 References ............................................................................................................................................. 174 

CHAPTER 7: Summary and Conclusions ..................................................................................................... 186 

7.1 Main Findings......................................................................................................................................... 186 

7.2 Discussion .............................................................................................................................................. 193 

7.3 Strengths and Limitations ...................................................................................................................... 201 

7.3 Future directions ....................................................................................................................... ............ 202 

7.4 References .............................................................................................................................................. 206 

About this Dissertation

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School	Laney Graduate School
Department	Nutrition and Health Sciences
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Psychology, Developmental Health Sciences, Epidemiology Health Sciences, Nutrition
Keyword	psychosocial stimulation Structural Equation Modeling cognitive development first 1,000 days linear growth socio-emotional development
Committee Chair / Thesis Advisor	Stein, Aryeh , Emory University
Committee Members	Martorell, Reynaldo, Emory University Hoddinott, John , Cornell University Ramirez-Zea, Manuel, INCAP Waford, Rachel , Emory University Patel, Shivani, Emory University

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