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Using structural equation modelling to assess factors influencing children’s growth and nutrition in rural China

  • Zixi Cheng (a1) (a2), Ling Shi (a3), Ying Li (a1), Yan Wang (a1) and Jingxu Zhang (a1) (a2)...
Abstract
Objective

Children’s poor growth and nutrition status has serious consequences and therefore it is important to understand its contributing factors.

Design

A community-based interventional study focusing on child feeding was conducted in a rural community in China. Data from the intervention group at baseline (1–4 months of age) and follow-up visits (12 and 18 months of age) were used in the present study (n 236). A structural equation model was generated to explore the effects of family wealth, household food safety, dietary intake, diseases and other factors on the growth and nutrition of young children.

Results

Mother’s knowledge and behaviours on household food safety had positive effects on children’s weight-for-age Z-score (WAZ; β direct=0·03 and 0·15, respectively, at 12 months of age; β direct=0·02 and 0·08, respectively, at 18 months; P<0·05) and weight-for-length Z-score (WLZ; β direct=0·04 and 0·21, respectively, at 12 months of age; β direct=0·01 and 0·06, respectively, at 18 months; P<0·05). While mothers’ feeding behaviours and children’s dietary intake at 12 months of age were positively associated with WAZ and/or WLZ at current and later ages, children’s diseases were negatively associated with WAZ and WLZ cross-sectionally.

Conclusions

Caregiver’s knowledge and feeding behaviours, and children’s dietary intake and diseases, are factors influencing the WAZ and WLZ of children. Promoting feeding and health knowledge and behaviours at early stages of childhood can improve children’s physical growth at later ages.

Copyright
Corresponding author
* Corresponding author: Email jxzhang@bjmu.edu.cn
Footnotes
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Zixi Cheng and Ling Shi contributed equally to this work.

Footnotes
References
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1. Black, RE, Allen, LH, Bhutta, ZA et al. (2008) Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371, 243260.
2. World Health Organization (2014) Global Nutrition Targets 2025: Stunting Policy Brief. Geneva: WHO.
3. Black, RE, Victora, CG, Walker, SP et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.
4. World Health Organization (2014) Global Nutrition Targets 2025: Childhood Overweight Policy Brief. Geneva: WHO.
5. Tzioumis, E & Adair, LS (2014) Childhood dual burden of under- and overnutrition in low- and middle-income countries: a critical review. Food Nutr Bull 35, 230243.
6. World Health Organization (2016) World Health Statistics 2015. Geneva: WHO.
7. Walker, SP, Chang, SM, Powell, CA et al. (2007) Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr 137, 24642469.
8. Olofin, I, Mcdonald, CM, Ezzati, M et al. (2013) Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies. PLoS One 8, e64636.
9. Pelletier, D, Frongillo, EA, Schroeder, DG et al. (1995) The effect of malnutrition on child mortality in developing countries. Bull World Health Organ 73, 443448.
10. Caulfield, LE, De Onis, M, Blossner, M et al. (2004) Undernutrition as an underlying cause of child deaths associated with diarrhoea, pneumonia, malaria, and measles. Am J Clin Nutr 80, 193198.
11. Zhang, J, Himes, JH, Guo, Y et al. (2013) Birth weight, growth and feeding pattern in early infancy predict overweight/obesity status at two years of age: a birth cohort study of Chinese infants. PLoS One 8, e64542.
12. Engeland, A, Bjorge, T, Sogaard, AJ et al. (2003) Body mass index in adolescence in relation to total mortality: 32-year follow-up of 227,000 Norwegian boys and girls. Am J Epidemiol 157, 517523.
13. Gunnell, D, Frankel, S, Nanchahal, K et al. (1998) Childhood obesity and adult cardiovascular mortality: a 57-year follow-up study based on the Boyd Orr Cohort. Am J Clin Nutr 67, 11111118.
14. Dietz, WH (1998) Childhood weight affects adult morbidity and mortality. J Nutr 128, 411414.
15. UNICEF (1990) Strategy for Improved Nutrition of Children and Women in Developing Countries. New York: UNICEF.
16. Dewey, KG & Aduafarwuah, S (2008) Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr 4, 2485.
17. Willmott, M, Nicholson, A, Busse, H et al. (2016) Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis. Arch Dis Child 101, 4250.
18. Sreeramareddy, CT, Ramakrishnareddy, N & Subramaniam, M (2015) Association between household food access insecurity and nutritional status indicators among children aged <5 years in Nepal: results from a national, cross-sectional household survey. Public Health Nutr 18, 29062914.
19. Richard, SA, Black, RE, Gilman, RH et al. (2013) Diarrhea in early childhood: short-term association with weight and long-term association with length. Am J Epidemiol 178, 11291138.
20. Zhang, J, Shi, L, Chen, D et al. (2013) Effectiveness of an educational intervention to improve child feeding practices and growth in rural China: updated results at 18 months of age. Matern Child Nutr 9, 118129.
21. Shi, L, Zhang, J, Wang, Y et al. (2010) Effectiveness of an educational intervention on complementary feeding practices and growth in rural China: a cluster randomised controlled trial. Public Health Nutr 13, 556565.
22. Cogill, B (2013) Anthropometric Indicators Measurement Guide. Washington, DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development.
23. Chinese Nutrition Society (2013) Chinese Resident Meals Nutrition DRIs of 2013 Version. Beijing: Science Press.
24. World Health Organization & UNICEF (2009) WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. A Joint Statement by the World Health Organization and the United Nations Children’s Fund . Geneva: WHO.
25. Hu, L & Bentler, PM (2009) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling 6, 155.
26. Tabachnick, BG & Fidell, LS (2007) Using Multivariate Statistics, 5th ed. New York: Allyn and Bacon.
27. Bentler, PM & Bonett, DG (1980) Significance tests and goodness-of-fit in the analysis of covariance structures. Psychol Bull 88, 588606.
28. Rigdon, EE (2009) CFI versus RMSEA: a comparison of two fit indexes for structural equation modeling. Struct Equ Modeling 3, 369379.
29. Browne, MW & Cudeck, R (1993) Alternate ways of assessing model fit. Sociol Methods Res 21, 230258.
30. Wu, ML (2010) Structural Equation Modelling – Operation and Application of AMOS Software, 2nd ed. Chongqing: Chongqing University Press.
31. Wang, L, Chen, Y, Zhang, Y et al. (2016) Application of Z score in evaluating the scores of biliary atresia patients after Kasai procedure. Chin J Pediatr Surg 37, 331335.
32. Psaki, S, Bhutta, ZA, Ahmed, T et al. (2012) Household food access and child malnutrition: results from the eight-country MAL-ED study. Popul Health Metr 10, 24.
33. Saha, KK, Frongillo, EA, Alam, DS et al. (2009) Household food security is associated with growth of infants and young children in rural Bangladesh. Public Health Nutr 12, 15561562.
34. Dewey, KG & Mayers, DR (2011) Early child growth: how do nutrition and infection interact? Matern Child Nutr 7, 129142.
35. Checkley, W, Epstein, LD, Gilman, RH et al. (1998) Effects of cryptosporidium parvum infection in Peruvian children: growth faltering and subsequent catch-up growth. Am J Epidemiol 148, 497506.
36. Wierzba, TF, Elyazeed, RA, Savarino, SJ et al. (2001) The interrelationship of malnutrition and diarrhea in a periurban area outside Alexandria, Egypt. J Pediatr Gastroenterol Nutr 32, 189196.
37. Richard, SA, Black, RE & Checkley, W (2012) Revisiting the relationship of weight and height in early childhood. Adv Nutr 3, 250254.
38. Zwane, AP & Kremer, M (2007) What works in fighting diarrheal diseases in developing countries? A critical review. World Bank Res Obs 22, 124.
39. Curtis, V & Cairncross, S (2003) Effect of washing hands with soap on diarrhea risk in the community: a systematic review. Lancet Infect Dis 3, 275281.
40. Fewtrell, L, Kaufmann, RB, Kay, D et al. (2005) Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5, 4252.
41. Rabie, T & Curtis, V (2006) Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 11, 258267.
42. Dangour, AD, Watson, L, Cumming, O et al. (2013) Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. Cochrane Database Syst Rev 8, CD009382.
43. Bhutta, ZA, Ahmed, T, Black, RE et al. (2008) What works? Interventions for maternal and child undernutrition and survival. Lancet 371, 417440.
44. Majamanda, J, Maureen, D, Munkhondia, T et al. (2014) The effectiveness of community-based nutrition education on the nutrition status of under-five children in developing countries. A systematic review. Malawi Med J 26, 115118.
45. Shi, L & Zhang, J (2011) Recent evidence of the effectiveness of educational interventions for improving complementary feeding practices in developing countries. J Trop Pediatr 57, 9198.
46. Lassi, ZS, Das, JK, Zahid, G et al. (2013) Impact of education and provision of complementary feeding on growth and morbidity in children less than 2 years of age in developing countries: a systematic review. BMC Public Health 13, s3s13.
47. Bian, R, Che, HS & Yang, H (2007) Item parceling strategies in structural equation modeling. Adv Psychol Sci 15, 567576.
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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
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