Childhood stunting in relation to the pre- and postnatal environment during the first 2 years of life : The MAL-ED longitudinal birth cohort study
BACKGROUND: Stunting is the most prevalent manifestation of childhood malnutrition. To characterize factors that contribute to stunting in resource-poor settings, we studied a priori selected biological and social factors collected longitudinally in a cohort of newborns.
METHODS AND FINDINGS: We enrolled 1,868 children across 7 resource-poor settings in Bangladesh, Brazil, India, Nepal, Peru, South Africa, and Tanzania shortly after birth and followed them for 24 months between 2 November 2009 and 28 February 2014. We collected longitudinal anthropometry, sociodemographic factors, maternal-reported illnesses, and antibiotic use; child feeding practices; dietary intake starting at 9 months; and longitudinal blood, urine, and stool samples to investigate non-diarrheal enteropathogens, micronutrients, gut inflammation and permeability, and systemic inflammation. We categorized length-for-age Z-scores into 3 groups (not stunted, ≥-1; at risk, <-1 to -2; and stunted, <-2), and used multivariable ordinal logistic regression to model the cumulative odds of being in a lower length-for-age category (at risk or stunted). A total of 1,197 children with complete longitudinal data were available for analysis. The prevalence of having a length-for-age Z-score below -1 increased from 43% (range 37%-47% across sites) shortly after birth (mean 7.7 days post-delivery, range 0 to 17 days) to 74% (16%-96%) at 24 months. The prevalence of stunting increased 3-fold during this same time period. Factors that contributed to the odds of being in a lower length-for-age category at 24 months were lower enrollment weight-for-age (interquartile cumulative odds ratio = 1.82, 95% CI 1.49-2.23), shorter maternal height (2.38, 1.89-3.01), higher number of enteropathogens in non-diarrheal stools (1.36, 1.07-1.73), lower socioeconomic status (1.75, 1.20-2.55), and lower percent of energy from protein (1.39, 1.13-1.72). Site-specific analyses suggest that reported associations were similar across settings. While loss to follow-up and missing data are inevitable, some study sites had greater loss to follow-up and more missing data than others, which may limit the generalizability of the findings.
CONCLUSIONS: Neonatal and maternal factors were early determinants of lower length-for-age, and their contribution remained important throughout the first 24 months of life, whereas the average number of enteropathogens in non-diarrheal stools, socioeconomic status, and dietary intake became increasingly important contributors by 24 months relative to neonatal and maternal factors.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
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| Enthalten in: |
PLoS medicine - 14(2017), 10 vom: 25. Okt., Seite e1002408 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
MAL-ED Network Investigators [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 30.10.2017 Date Revised 12.11.2023 published: Electronic-eCollection Citation Status MEDLINE |
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| doi: |
10.1371/journal.pmed.1002408 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM277372704 |
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| 500 | |a Date Revised 12.11.2023 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Stunting is the most prevalent manifestation of childhood malnutrition. To characterize factors that contribute to stunting in resource-poor settings, we studied a priori selected biological and social factors collected longitudinally in a cohort of newborns | ||
| 520 | |a METHODS AND FINDINGS: We enrolled 1,868 children across 7 resource-poor settings in Bangladesh, Brazil, India, Nepal, Peru, South Africa, and Tanzania shortly after birth and followed them for 24 months between 2 November 2009 and 28 February 2014. We collected longitudinal anthropometry, sociodemographic factors, maternal-reported illnesses, and antibiotic use; child feeding practices; dietary intake starting at 9 months; and longitudinal blood, urine, and stool samples to investigate non-diarrheal enteropathogens, micronutrients, gut inflammation and permeability, and systemic inflammation. We categorized length-for-age Z-scores into 3 groups (not stunted, ≥-1; at risk, <-1 to -2; and stunted, <-2), and used multivariable ordinal logistic regression to model the cumulative odds of being in a lower length-for-age category (at risk or stunted). A total of 1,197 children with complete longitudinal data were available for analysis. The prevalence of having a length-for-age Z-score below -1 increased from 43% (range 37%-47% across sites) shortly after birth (mean 7.7 days post-delivery, range 0 to 17 days) to 74% (16%-96%) at 24 months. The prevalence of stunting increased 3-fold during this same time period. Factors that contributed to the odds of being in a lower length-for-age category at 24 months were lower enrollment weight-for-age (interquartile cumulative odds ratio = 1.82, 95% CI 1.49-2.23), shorter maternal height (2.38, 1.89-3.01), higher number of enteropathogens in non-diarrheal stools (1.36, 1.07-1.73), lower socioeconomic status (1.75, 1.20-2.55), and lower percent of energy from protein (1.39, 1.13-1.72). Site-specific analyses suggest that reported associations were similar across settings. While loss to follow-up and missing data are inevitable, some study sites had greater loss to follow-up and more missing data than others, which may limit the generalizability of the findings | ||
| 520 | |a CONCLUSIONS: Neonatal and maternal factors were early determinants of lower length-for-age, and their contribution remained important throughout the first 24 months of life, whereas the average number of enteropathogens in non-diarrheal stools, socioeconomic status, and dietary intake became increasingly important contributors by 24 months relative to neonatal and maternal factors | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Checkley, William |e investigator |4 oth | |
| 700 | 1 | |a Mouksassi, Samer |e investigator |4 oth | |
| 700 | 1 | |a Carreon, J Daniel |e investigator |4 oth | |
| 700 | 1 | |a McCormick, Benjamin J |e investigator |4 oth | |
| 700 | 1 | |a Mahfuz, Mustafa |e investigator |4 oth | |
| 700 | 1 | |a Gottlieb, Michael |e investigator |4 oth | |
| 700 | 1 | |a Knobler, Stacey L |e investigator |4 oth | |
| 700 | 1 | |a Lang, Dennis R |e investigator |4 oth | |
| 700 | 1 | |a Miller, Mark A |e investigator |4 oth | |
| 700 | 1 | |a Bhutta, Zulfiqar A |e investigator |4 oth | |
| 700 | 1 | |a Caulfield, Laura |e investigator |4 oth | |
| 700 | 1 | |a Guerrant, Richard L |e investigator |4 oth | |
| 700 | 1 | |a Houpt, Eric |e investigator |4 oth | |
| 700 | 1 | |a Kosek, Margaret N |e investigator |4 oth | |
| 700 | 1 | |a Murray-Kolb, Laura E |e investigator |4 oth | |
| 700 | 1 | |a Petri, William A |e investigator |4 oth | |
| 700 | 1 | |a Seidman, Jessica C |e investigator |4 oth | |
| 700 | 1 | |a Bessong, Pascal |e investigator |4 oth | |
| 700 | 1 | |a Haque, Rashidul |e investigator |4 oth | |
| 700 | 1 | |a John, Sushil |e investigator |4 oth | |
| 700 | 1 | |a Kang, Gangandeep |e investigator |4 oth | |
| 700 | 1 | |a Lima, Aldo A M |e investigator |4 oth | |
| 700 | 1 | |a Mduma, Estomih R |e investigator |4 oth | |
| 700 | 1 | |a Oria, Reinaldo |e investigator |4 oth | |
| 700 | 1 | |a Shrestha, Sanjaya Kumar |e investigator |4 oth | |
| 700 | 1 | |a Svensen, Erling |e investigator |4 oth | |
| 700 | 1 | |a Zaidi, Anita K M |e investigator |4 oth | |
| 700 | 1 | |a Abreu, Claudia B |e investigator |4 oth | |
| 700 | 1 | |a Ahmed, Imran |e investigator |4 oth | |
| 700 | 1 | |a Ali, Asad |e investigator |4 oth | |
| 700 | 1 | |a Ambikapathi, Ramya |e investigator |4 oth | |
| 700 | 1 | |a Bayyo, Elizawa |e investigator |4 oth | |
| 700 | 1 | |a Bose, Anuradha |e investigator |4 oth | |
| 700 | 1 | |a Chandayo, Ram Krishna |e investigator |4 oth | |
| 700 | 1 | |a Dillingham, Rebecca |e investigator |4 oth | |
| 700 | 1 | |a Platts-Mills, James |e investigator |4 oth | |
| 700 | 1 | |a Ahmed, Tahmeed |e investigator |4 oth | |
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