uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Stunting, recovery from stunting and puberty timing in the MINIMat cohort, Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
International Centre for Diarrhoeal Disease Research, Bangladesh .
International Centre for Diarrhoeal Disease Research, Bangladesh .
International Centre for Diarrhoeal Disease Research, Bangladesh .
Show others and affiliations
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Nutritional status is a well-known determinant of pubertal development and age at menarche. In low-resource settings, puberty onset usually takes place at an older age. Epidemiological and adoption studies have indicated that early life undernutrition that is followed by catch-up growth may result in early puberty and younger age at menarche. Early puberty might, in turn, be associated with an increased risk of adult chronic diseases. This paper aims to analyze the association between intrauterine growth restriction, infancy and childhood stunting, recovery from stunting, and the outcome timing of puberty in a rural Bangladeshi cohort.

Methods: The participants in the present study were children to mothers participating in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) trial. Pregnant women were identified in early pregnancy, and a birth cohort was followed from birth to puberty. The analyzed sample included 994 girls and 987 boys aged from 12 to 15 years. Puberty assessment was done by evaluating the breast, testicle, and hair developments according to Tanner. The age at menarche was recorded and in boys data from pre-pubertal and two consecutive pubertal height measurements, six months apart were used to determine whether the pubertal growth spurt had started or not. Intrauterine growth restriction, infancy and childhood stunting, and recovery from stunting were modeled with age at menarche by Cox proportional hazards analyses, and with pubertal onset in boys by logistic regression.

Results: The median age at menarche was 13.0 years (95% CI 13.0-13.1). Adolescents, who had reached a later stage of puberty and had a younger age at menarche, had mothers who were heavier, more educated, and belonged to a higher socioeconomic group. There was no difference in age at menarche between girls that were small or appropriate for gestational age at birth. Boys born small for gestational age entered their pubertal growth spurt later than those with appropriate weight. Children who were stunted had later pubertal development, age at menarche and timing of growth spurt than non-stunted children. Children who recovered from stunting had similar pubertal development, age at menarche, and timing of growth spurt in boys as non-stunted children.

Conclusion: Infant and childhood stunting was associated with a later pubertal development. Infant or young child recovery from stunting was not associated with earlier puberty in comparison with non-stunted children.

Keywords [en]
Stunting, Undernutrition, Puberty, Recovery, Menarche, Tanner, Bangladesh, Adolescence
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-347523OAI: oai:DiVA.org:uu-347523DiVA, id: diva2:1194861
Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-04-04
In thesis
1. Stunted growth in children from fetal life to adolescence: Risk factors, consequences and entry points for prevention - Cohort studies in rural Bangladesh
Open this publication in new window or tab >>Stunted growth in children from fetal life to adolescence: Risk factors, consequences and entry points for prevention - Cohort studies in rural Bangladesh
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Stunted growth affects one in four children under the age of five years and comes with great costs for the child and society. With an increased understanding of the long-term consequences of chronic undernutrition the reduction of stunted growth has become an important priority on the global health agenda. WHO has adopted a resolution to reduce stunting by 40% by the year 2025 and to reduce stunting is one of the targets under the Sustainable Development Goals.

The aim of this thesis was to study linear growth trajectories, risk factors and consequences of stunting and recovery of stunting from fetal life to adolescence in a rural Bangladeshi setting and to assess the cost-effectiveness of a prenatal nutrition intervention for under-five survival and stunting.

A birth cohort of children of women participating in the Maternal and Infant Nutrition Interventions trial (MINIMat), a randomized prenatal food and multiple micronutrient (MMS) trial, was followed from birth to adolescence. Information about socioeconomic and nutritional characteristics of the mother and father was collected, and frequent anthropometry assessments of the child were done at birth, in infancy, and during childhood and adolescence. At puberty, pubertal stages according to Tanner, age at menarche and start of the pubertal growth spurt in boys were assessed. Calculations were made regarding the cost-effectiveness of prenatal food and micronutrient intervention related to the disability adjusted life years (DALYs) lost by death and stunting.

At birth, the children were on average short compared the WHO growth reference and more than half of the children were Small-for-Gestational-Age. Linear growth faltered dramatically up to 2 years, after which height-for-age Z-score increased up to adolescence. The prevalence of stunting was highest at 2 years (50%) and thereafter decreasing to 25% in adolescence. Birth size, maternal anthropometry and parental education were the most influential factors for linear growth up to and stunting at 2 years. Conditions after birth, such as feeding practices and morbidity, were less important. At 10 years, children born to short mothers (<147.5 cm), mothers with no education, or those conceived in the pre-monsoon season had an increased probability to be stunted. The median age at menarche was 13.0 years. Children that were stunted in infancy and childhood had later pubertal development as compared to non-stunted children. Children that recovered from stunting had a similar timing of puberty as their peers who had never been stunted. Supplementation with combined early prenatal food and multiple micronutrients was highly cost-effective in averting DALYs from under-five deaths and stunting.

The results from this thesis support the conclusion that a lifecycle approach is needed for the prevention of stunting. The gaps between current knowledge, policy and practice needs to be closed, with more emphasis given to prenatal interventions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1453
Keywords
stunting, linear growth, child health, undernutrition, Bangladesh, cost-effectiveness, data mining, puberty, prenatal interventions, global health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-347524 (URN)978-91-513-0305-5 (ISBN)
Public defence
2018-05-25, Gustavianum, Akademigatan 3, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2018-05-03 Created: 2018-04-04 Last updated: 2018-05-03

Open Access in DiVA

No full text in DiVA

Authority records BETA

Svefors, PernillaEkström, Eva-CharlotteEkholm Selling, Katarina

Search in DiVA

By author/editor
Svefors, PernillaEkström, Eva-CharlotteEkholm Selling, Katarina
By organisation
Department of Women's and Children's HealthInternational Child Health and Nutrition
Public Health, Global Health, Social Medicine and Epidemiology

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 105 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf