Effectiveness of early‑childhood nutrition and supplementation programs on cognitive development and stunting

Abstract

Background: Early childhood, particularly the first 1,000 days, is a critical period for brain development and physical growth. Malnutrition during this stage can lead to long-term impairments in cognitive function and linear growth. Despite widespread implementation of nutrition and supplementation programs, their long-term effectiveness remains inconsistent, particularly in low- and middle-income countries Objectives: To systematically evaluate the effectiveness of early-childhood nutrition and supplementation programs on cognitive development and stunting among children aged 0–5 years Methods A systematic search of PubMed and Google Scholar was conducted for studies published since 2011. Eligible studies included randomized controlled trials, cluster-randomized trials, quasi-experimental studies, and cohort studies involving children aged 0–5 years. Interventions included macronutrient supplementation, micronutrient supplementation, fortified foods, and integrated programs combining nutrition with stimulation or education. Primary outcomes were cognitive development and stunting; secondary outcomes included underweight, wasting, motor development, anemia, and micronutrient status. Fourteen studies were included. Results: out of the 9,248 screened records, 20 studies were included according to the inclusion criteria. Dental caries (RR: 1.45-2.10) and obesity (RR: 1.20-1.35) were always related to the high levels of free sugar. There was an increase in the risk of periodontitis (OR: 1.29, 95% CI: 1.17-1.42) and T2D risk (HR: 1.44, 95% CI: 1.29-1.62) with the consumption of ultra-processed food. Mechanistic evidence supported the existence of a bidirectional relationship with periodontitis and diabetes (GRADE: Moderate-High). Defensive dietary habits (Mediterranean, DASH) proved to be beneficial in terms of results. Combined measures were to use sugar sweetened drinks taxation, combined dietary-fluoride, and coordinated clinical screening. Conclusions: Early-childhood interventions are most effective when nutrition is combined with psychosocial stimulation and sustained behavioral support. Isolated micronutrient supplementation has limited impact on long term cognitive and growth outcomes. Integrated, long-term strategies are essential for achieving meaningful improvements in child development