Diet and development among children aged 36-59 months in low-income countries

Arch Dis Child. 2022 Aug;107(8):719-725. doi: 10.1136/archdischild-2021-323218. Epub 2021 Dec 24.


Objective: To assess the associations between diet, stimulation and development among children 36-59 months of age in low-income and middle-income countries (LMICs).

Design: We pooled Demographic and Health Survey data on 12 126 children aged 36-59 months from 15 LMICs. Child diet indicators included dietary diversity score (DDS, range 0-7), minimum dietary diversity (MDD, defined as DDS ≥4) and animal source foods (ASFs) consumption. Child development was assessed using the Early Childhood Development Index and stimulation by the number of stimulation activities (range 0-6). Associations were assessed using generalised linear models.

Results: In our sample, 18% of children met MDD and 50% received ≥4 stimulation activities. The prevalence of suboptimal cognitive, socioemotional, literacy-numeracy and physical development was 24%, 32%, 87% and 11%, respectively. Higher DDS, meeting MDD and consuming ASFs were associated with 8%-13% more stimulation activities. Children who met MDD were slightly less likely to have suboptimal literacy-numeracy development compared with children who did not meet MDD: relative risk 0.97 (95% CI 0.95 to 1.00). DDS, meeting MDD and ASFs consumption were not associated with cognitive, socioemotional or physical development. However, there was evidence of positive associations between MDD and cognitive and literacy-numeracy development among subgroups of children, including those who received ≥4 stimulation activities or attended an early childhood care and education programme.

Conclusions: Child diet was associated with more stimulation activities. However, independent of stimulation, socioeconomic status and other factors, child diet appeared to be a prominent determinant only of literacy-numeracy development among children 36-59 months of age.

Keywords: child development; child health; global health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child Development
  • Child, Preschool
  • Developing Countries
  • Diet*
  • Humans
  • Poverty*
  • Social Class