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Stunted at 10 Years. Linear Growth Trajectories and Stunting from Birth to Pre-Adolescence in a Rural Bangladeshi Cohort.
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 (iccdr,b), Dhaka, Bangladesh.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell sexuell och reproduktiv hälsa/Larsson)
International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh.
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, article id e0149700Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Few studies in low-income settings analyse linear growth trajectories from foetal life to pre-adolescence. The aim of this study is to describe linear growth and stunting from birth to 10 years in rural Bangladesh and to analyse whether maternal and environmental determinants at conception are associated with linear growth throughout childhood and stunting at 10 years.

METHODS AND FINDINGS: Pregnant women participating in the MINIMat trial were identified in early pregnancy and a birth cohort (n = 1054) was followed with 19 growth measurements from birth to 10 years. Analyses of baseline predictors and mean height-for-age Z-scores (HAZ) over time were modelled using GLMM. Logistic regression analysis was used to investigate the associations between baseline predictors and stunting (HAZ<-2) at 10 years. HAZ decreased to 2 years, followed by an increase up to 10 years, while the average height-for-age difference in cm (HAD) to the WHO reference median continued to increase up to 10 years. Prevalence of stunting was highest at 2 years (50%) decreasing to 29% at 10 years. Maternal height, maternal educational level and season of conception were all independent predictors of HAZ from birth to pre-adolescence (p<0.001) and stunting at 10 years. The highest probability to be stunted at 10 years was for children born by short mothers (<147.5 cm) (ORadj 2.93, 95% CI: 2.06-4.20), mothers with no education (ORadj 1.74, 95% CI 1.17-2.81) or those conceived in the pre-monsoon season (ORadj 1.94, 95% CI 1.37-2.77).

CONCLUSIONS: Height growth trajectories and prevalence of stunting in pre-adolescence showed strong intergenerational associations, social differentials, and environmental influence from foetal life. Targeting women before and during pregnancy is needed for the prevention of impaired child growth.

Place, publisher, year, edition, pages
2016. Vol. 11, no 3, article id e0149700
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-280082DOI: 10.1371/journal.pone.0149700ISI: 000371724200047PubMedID: 26934484OAI: oai:DiVA.org:uu-280082DiVA, id: diva2:910054
Funder
Sida - Swedish International Development Cooperation AgencySwedish Research Council
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2018-04-04Bibliographically approved
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
Keyword
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

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Svefors, PernillaRahman, AnisurEkström, Eva-CharlotteKhan, Ashraful IslamLindström, EmmaPersson, Lars ÅkeEkholm Selling, Katarina

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