Abstract
BackgroundFew 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 FindingsPregnant 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).ConclusionsHeight 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.
Highlights
Child undernutrition remains one of the main global health challenges in low and middleincome countries (LMIC) [1]
The authors gratefully acknowledge the participation of all mothers and children in Matlab
We found that the trend of height-for-age Z-scores (HAZ) over time was best explained by including a second order polynomial (Time2) in the models
Summary
Child undernutrition remains one of the main global health challenges in low and middleincome countries (LMIC) [1]. Stunting of linear growth (low height for age) is currently the most dominant form of child undernutrition and is estimated to affect over 165 million children globally before the age of five years [1].Stunting, defined as an attained height below -2 standard deviations (SD) of the WHO growth reference median, indicates a failure to reach one’s potential for linear growth and is an acknowledged way of representing child health inequalities[2,3]. Linear growth retardation is associated with future negative health consequences, such as impaired cognitive development, reduced economic productivity in adulthood, unfavourable maternal reproductive outcomes and a risk of development of non-communicable diseases [12]. Understanding child growth patterns is critical in order to develop appropriate interventions to reduce stunting and its short- and long-term consequences for individuals and society. The concept of the first 1000 days, starting at conception, has been developed as the most important period for nutritional interventions
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