Exploration of non‐nutritional factors associated with stunting in 24 month old children of rural Bangladesh

Abstract

Nutrition interventions in the critical first 2 years of life have had only modest effects on stunting, a length for age Z‐score (LAZ) < ‐ 2, suggesting that non‐nutritional factors contribute to compromised growth. We are assessing gut permeability and environmental exposures at 24 mo of age as potential causes of linear growth deceleration in 180 children of rural Bangladesh, where over half of children are stunted. Data on health, maternal and infant diet, and growth were characterized from the intrauterine period to 24 mo of age in children in the context of a community‐based, randomized trial to assess maternal antenatal micronutrient supplements on birth outcomes. Mean (±SD) LAZ (% stunted) was −1.47±1.2 (29%) at birth (n=178), −1.37±1.19 (22%) at 6 mo (n=169), −1.86±1.12 (42%) at 12 mo (n=162), and −1.97±1.11 (46%) (n=121) at 24 mo, revealing increasingly compromised linear growth after 6 mo, consistent with timing of complementary feeding and enhanced exposure to pathogenic stimuli. Gut permeability assessed by the lactulose:mannitol test; chronic pathogenic exposure assessed by elevated immunoglobulins, cytokines, and acute phase markers; and aflatoxin exposure at 24 mo will be presented. Associations of these factors with LAZ and individual growth trajectories will be explored. Support: Gates Foundation Grant 614, Grand Challenges Exploration