Associations between feeding practices and growth and neurodevelopmental outcomes at 36 months among children living in low- and low-middle income countries who participated in the BRAIN-HIT trial

Do, Barbara T.; Hansen, Nellie I.; Bann, Carla; Lander, Rebecca L.; Goudar, Shivaprasad S.; Pasha, Omrana; Chomba, Elwyn; Dhaded, Sangappa M.; Thorsten, Vanessa R.; Wallander, Jan L.; Biasini, Fred J.; Derman, Richard; Goldenberg, Robert L.; Carlo, Waldemar A.

Feeding practices over the first several years of a child’s life can critically influence development. The purpose of this study was to examine associations between feeding practices and growth and neurodevelopmental outcomes at 36 months of age among children from low- and low-middle-income countries (LMIC).

We conducted a secondary analysis using data collected from children in India, Pakistan, and Zambia who were enrolled in a randomized controlled trial of a home-based early development intervention program called Brain Research to Ameliorate Impaired Neurodevelopment Home-based Intervention Trial. Qualitative dietary data collected at 36 months was used to assess the modified Minimum Acceptable Diet (mMAD), a measure based on a core indicator developed by the World Health Organization to measure whether young children receive the minimum number of meals recommended and adequate diversity of major food groups in their diet. Regression models were used to assess cross-sectional associations between diet and growth indices, including Z-scores for height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ), head circumference (HCZ), and Bayley Scales of Infant Development II mental and psychomotor developmental measures at 36 months of age.

Of 371 children, 174 (47%) consumed the mMAD, with significantly higher mean adjusted WHZ than those who did not meet mMAD (0.20 vs − 0.08, p = 0.05). Egg consumption was found to be significantly associated with a decreased risk of wasting [adjusted RR (95% CI): 0.37 (0.15, 0.89), p = 0.03]. HCZ at 36 months did not differ significantly for children who did and did not receive the mMAD.

Meeting the mMAD was associated with better weight-for-height outcomes at 36 months in children in these three LMIC, highlighting the importance of adequate food quantity and quality.

Trial registration


registered on March 20, 2008.


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Academic Units
Obstetrics and Gynecology
Published Here
August 20, 2018


Bayley scores of infant development, Developmental outcome, Stunting, Wasting, Dietary diversity, Low- and middle-income countries