Acute Undernutrition and Child Development in Low- and Middle-Income Countries: A Meta-analysis

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CONTEXT: The association between linear growth faltering and child development outcomes is generally well recognized; however, the relationship between metrics of acute undernutrition and development has received less attention. OBJECTIVES: We aimed to quantify the association between metrics of acute undernutrition in childhood with development outcomes in low- and middle-income countries (LMICs). METHODS: We conducted a systematic literature review of observational studies that assessed the association between metrics of acute undernutrition, including body mass index-for-age z score (BMIZ), midupper arm circumference (MUAC), weight-for-height/-length z score (WHZ/WLZ), wasting (WHZ/WLZ < -2), and severe acute malnutrition (SAM) among children under 5 years of age with cognitive, motor, language, and socioemotional development assessed to 19 years of age. We estimated the pooled correlation and standardized mean difference (SMD) for cross-sectional and longitudinal studies. RESULTS: A total of 113 studies from 40 LMICs were identified. Metrics of acute undernutrition were associated with lower cognitive and motor development scores. In longitudinal studies that reported multivariable-adjusted estimates for the cognitive domain, SAM was associated with -1.06 SD lower scores (95% CI: -1.41, -0.72) compared with children without SAM. SAM was also associated with lower motor scores in longitudinal studies with unadjusted estimates (SMD: -0.42; 95% CI: -0.68, -0.15). In longitudinal studies with multivariable estimates, wasting was associated with lower motor scores (SMD: -0.30; 95% CI: -0.54, -0.06), but there was no association with language (SMD: -0.08; 95% CI: -0.24, 0.07) or prosocial development scores (SMD: -0.18; 95% CI: -0.38, 0.02). CONCLUSION: Metrics of acute undernutrition in childhood were consistently associated with lower development scores, and the magnitude appeared stronger for children with SAM or wasting. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022310077.

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