Publications

INTRODUCTION: Prevalence of undernutrition continues to be high in India and low household wealth is consistently associated with undernutrition. This association  could be modified through improved dietary intake, including dairy consumption in  young children. The beneficial effect of dairy on child growth has not been  explored at a national level in India. The present analyses aimed to evaluate the  direct and indirect (modifying association of household level per adult female  equivalent milk and milk product consumption) associations between household  wealth index on height for age (HAZ) and weight for age (WAZ) in 6-59 months old  Indian children using data from of nationally representative surveys. METHODS:  Two triangulated datasets of two rounds of National Family Health Survey, (NFHS-3  and 4) and food expenditure (National Sample Survey, NSS61 and 68) surveys, were  produced by statistical matching of households using Non-Iterative Bayesian  Approach to Statistical Matching technique. A Directed Acyclic Graph was  constructed to map the pathways in the relationship of household wealth with HAZ  and WAZ based on literature. The direct association of wealth index and its  indirect association through per adult female equivalent dairy consumption on HAZ  and WAZ were estimated using separate path models for each round of the surveys.  RESULTS: Wealth index was directly associated with HAZ and WAZ in both the  rounds, but the association decreased from NFHS-3 (β(HAZ): 0.145; 95% CI: 0.129,  0.16) to NFHS-4 (β(HAZ): 0.102; 95%CI: 0.093, 0.11). Adult female equivalent milk  intake (increase of 10gm/day) was associated with higher HAZ (β_NFHS-3=0.001;95%  CI: 0, 0.002; β_NFHS-4=0.002;95% CI: 0.002, 0.003) but had no association with  WAZ. The indirect association of wealth with HAZ through dairy consumption was  2-fold higher in NFHS-4 compared to NFHS-3. CONCLUSIONS: The analysis of  triangulated survey data shows that household level per- adult female equivalent  dairy consumption positively modified the association between wealth index and  HAZ, suggesting that regular inclusion of milk and milk products in the diets of  children from households across all wealth quintiles could improve linear growth  in this population.