Relating anthropometric indicators to brain structure in 2-month-old Bangladeshi infants growing up in poverty: A pilot study

Ted Turesky,Wanze Xie,Swapna Kumar,Danielle D Sliva,Borjan Gagoski,Jennifer Vaughn,Lilla Zöllei,Rashidul Haque,Shahria Hafiz Kakon,Nazrul Islam,William A Petri,Charles A Nelson,Nadine Gaab

doi:10.1016/j.neuroimage.2020.116540

Abstract

Anthropometric indicators, including stunting, underweight, and wasting, have previously been associated with poor neurocognitive outcomes. This link may exist because malnutrition and infection, which are known to affect height and weight, also impact brain structure according to animal models. However, a relationship between anthropometric indicators and brain structural measures has not been tested yet, perhaps because stunting, underweight, and wasting are uncommon in higher-resource settings. Further, with diminished anthropometric growth prevalent in low-resource settings, where biological and psychosocial hazards are most severe, one might expect additional links between measures of poverty, anthropometry, and brain structure. To begin to examine these relationships, we conducted an MRI study in 2-3-month-old infants growing up in the extremely impoverished urban setting of Dhaka, Bangladesh. The sample size was relatively small because the challenges of investigating infant brain structure in a low-resource setting needed to be realized and resolved before introducing a larger cohort. Initially, fifty-four infants underwent T1 sequences using 3T MRI, and resulting structural images were segmented into gray and white matter maps, which were carefully evaluated for accurate tissue labeling by a pediatric neuroradiologist. Gray and white matter volumes from 29 infants (79 ± 10 days-of-age; F/M = 12/17), whose segmentations were of relatively high quality, were submitted to semi-partial correlation analyses with stunting, underweight, and wasting, which were measured using height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) scores. Positive semi-partial correlations (after adjusting for chronological age and sex and correcting for multiple comparisons) were observed between white matter volume and HAZ and WAZ; however, WHZ was not correlated with any measure of brain volume. No associations were observed between income-to-needs or maternal education and brain volumetric measures, suggesting that measures of poverty were not associated with total brain tissue volume in this sample. Overall, these results provide the first link between diminished anthropometric growth and white matter volume in infancy. Challenges of conducting a developmental neuroimaging study in a low-resource country are also described.

Highlights

Hundreds of millions of children worldwide fail to reach their full growth potential due to adverse circumstances in their environments (Bhutta et al, 2017; Black et al, 2017; GranthamMcGregor et al, 2007; John et al, 2017)
We examined the relationship between two measures of poverty, income-to-needs and years of maternal education, and gray and white matter volumes (G/WMV)
Despite the small sample size and other challenges, total gray and white matter volume (G/WMV) estimates were consistent with previous studies of infants scanned in a U.S.-based sample in the first few months of life (Gilmore et al, 2007; Knickmeyer et al, 2008)

Summary

Introduction

Hundreds of millions of children worldwide fail to reach their full growth potential due to adverse circumstances in their environments (Bhutta et al, 2017; Black et al, 2017; GranthamMcGregor et al, 2007; John et al, 2017). Identification could be especially beneficial in areas such as Sub-Saharan Africa and Southern Asia, where the prevalence of diminished growth is especially high (Hayashi et al, 2018). These indicators may be limited in their utility to characterize other aspects of diminished growth, such as compromised brain development. While brain structure has not yet been examined in the context of anthropometric indicators, the link between stunting, underweight and wasting and neurocognitive outcomes (de Onis and Branca, 2016; Donowitz et al, 2018; Fuglestad et al, 2008) suggests that compromised brain structure and function may be associated with these anthropometric indicators

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