Differential influences of early growth and social factors on young children's cognitive performance in four low-and-middle-income birth cohorts (Brazil, Guatemala, Philippines, and South Africa)

Background: Studies relating childhood cognitive development to poor linear growth seldom take adequate account of social conditions related to both, leading to a focus on nutrition interventions. We aimed to assess the roles of both biological and social conditions in determining early childhood cognition, mediated by birthweight and early linear growth. Methods: After exploratory structural equation modelling to identify determining factors, we tested direct and indirect paths to cognitive performance through birthweight and child height-for-age at 2 years, assessed between 4 and 8.5 years of age among 2448 children in four birth cohort studies in low-and-middle-income countries (Brazil, Guatemala, Philippines and South Africa). Determinants were compared across the cohorts. Findings: Three factors yielded excellent fit, comprising birth endowment (primarily maternal age and birth order), household resources (crowding, dependency) and parental capacity (parental education). We estimated their strength together with maternal height in determining cognitive performance. Percentage shares of total effects of the four determinants show a marked transition from mainly biological determinants of birth weight (birth endowment 34%) and maternal height (30%) compared to household resources (25%) and parental capacity (11%), through largely economic determinants of height at 2 years (household resources (60%) to cognitive performance being predominantly determined by parental capacity (64%) followed by household resources (29%). The largely biological factor, birth endowment (maternal age and birth order) contributed only 7% to childhood cognitive performance and maternal height was insignificant. In summary, the combined share of social total effects (household resources and parental capacity) rises from 36∙2% on birth weight, to 78∙2% on height for age at 24 m, and 93∙4% on cognitive functioning. Interpretation: Across four low- and middle-income contexts, cognition in childhood is influenced more by the parental capacity of families and their economic resources than by birth weight and early linear growth. Improving children's cognitive functioning requires multi-sectoral interventions to improve parental education and enhance their economic wellbeing, interventions that are known to improve also early childhood growth

Two countries, similar practices: The political practices of the food industry influencing the adoption of key public health nutrition policies in Guatemala and Panama.

OBJECTIVE: To identify the corporate political activity (CPA) strategies used by food industry actors during the development of two public health nutrition policies in Central America: Law #570 (taxation of sugar-sweetened beverages) in Panama, and Bill #5504 (labeling and food marketing regulations) in&nbsp;Guatemala. DESIGN: We triangulated data from publicly available information from 2018 to 2020, (e.g., industry and government materials; social media material) with semi-structured interviews with key&nbsp;stakeholders. SETTING: Guatemala and&nbsp;Panama. PARTICIPANTS: Government, academia and international organizations workers in health and&nbsp;nutrition. DESIGN: CPA strategies were categorized according to an existing internationally used taxonomy into action-based, instrumental strategies (coalition management, information management, direct involving and influence in policy, legal action) and discursive&nbsp;strategies. RESULTS: Instrumental strategies included the establishment of relationships with policy makers and direct lobbying against the proposed public policies. Discursive strategies were mainly criticizing on the unfounded ground that they lacked evidence of effectiveness and will imply negative impacts on the economy. The industry pointed at individuals for making their own food choices, in order to shift the focus away from the role of its products in contributing to&nbsp;ill-health. CONCLUSIONS: We provide evidence of the political practices used by the food industry to interfere with the development and implementation of public health nutrition policies to improve diets in Central America. Policy makers, public health advocates and the public should be informed about those practices and develop counter-strategies and arguments to protect public and policies from the vested interests of the food&nbsp;industry.</p