Linear Growth In Children Research Articles

Dairy trade liberalization and child stunting: Evidence from low- and middle-income countries

Despite the well-studied nutritional benefits of dairy for child linear growth, dairy is less consumed in low- and middle-income countries (LMICs) where the prevalence of child stunting is high. Previous studies have suggested the cost of dairy as a potential barrier to increased dairy consumption in these countries. Surprisingly, little research on the association between dairy consumption and child stunting in LMICs focuses on the role of trade policies, particularly the liberalization of dairy trade. To explore this, we use representative cross-country individual data on child stunting from 2006 to 2020 and link it with country-level dairy trade data. We find that a 10% decline in dairy tariff rates reduces the risk of stunting by 7.78%. Our results are robust to a subsample analysis excluding countries which joined the WTO after 2000 and to an alternative clustering method. As a falsification test, our results show child stunting is not linked with tariffs for coffee and tea. Heterogeneity analysis indicates the associations are more pronounced for boys, children aged 3–5, and children from households with lower socioeconomic status. Although we did not find significant rural–urban differences, the associations are indeed stronger for households without cattle and for countries in Western Africa, South East Asia and Europe and Central Asia. Mechanism analysis suggests that dairy tariffs are positively correlated with milk prices, while they are negatively associated with dairy import values. Lower dairy tariffs are also found to be linked with higher probability of child dairy consumption. Our findings highlight the importance of removing tariff barriers in reducing the cost of dairy and promoting dairy consumption in LMICs. This study has implications for repurposing dairy trade policies in creating nutrition-sensitive agriculture.

Effect of a Center-Based Early Childhood Care and Education Program on Child Nutritional Status: A Secondary Analysis of a Stepped-Wedge Cluster Randomized Controlled Trial in Rural Sindh, Pakistan

BackgroundHigh-quality early childhood care and education (ECCE) programs can positively impact children’s development. However, as an unintended consequence, ECCE attendance may also affect children’s nutritional status. ObjectiveWe evaluated the effect of a center-based ECCE intervention on child nutritional outcomes in rural Pakistan. MethodsThis study utilized data from a stepped-wedge cluster randomized controlled trial of a center-based ECCE program that trained female youth to run high-quality preschools for children aged 3.5–5.5 y (Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) program) in rural Sindh, Pakistan. The program did not include any school meals. A total of 99 village clusters were randomized to receive the LEAPS intervention in 3 steps, and repeated cross-sectional surveys were conducted to assess the impact on children (age: 4.5–5.5 y) at 4- time points. ITT analyses with multilevel mixed-effect models were used to estimate the effect of the intervention on child anthropometric outcomes. ResultsThe analysis included 3858 children with anthropometric data from 4 cross-sectional survey rounds. The LEAPS intervention was found to have a positive effect on child height-for-age z score (mean difference: 0.13 z-scores; 95% confidence interval [CI]: 0.02, 0.24). However, there was a negative effect on weight-based anthropometric indicators, −0.29 weight-for-height z score (WHZ) (95% CI: −0.42, −0.15), −0.13 BMI z score (BMIZ) (95% CI: −0.23, −0.03), and −0.16 mid-upper arm circumference-for-age z score MUACZ (95% CI: −0.25, −0.05). An exploratory analysis suggested that the magnitude of the negative effect of LEAPS on WHZ, BMIZ, and weight-for-age z score (WAZ) was greater in the survey round during the COVID-19 lockdown. DiscussionThe LEAPS intervention positively affected child linear growth but had negative effects on multiple weight-based anthropometric measures. ECCE programs in low- and middle-income country settings should evaluate the integration of nutrition-specific interventions (eg school lunch, counseling on healthy diets) and infection control strategies to promote children's healthy growth and development. Clinical Trial Registryclinicaltrials.gov, NCT03764436, https://clinicaltrials.gov/ct2/show/NCT03764436

Associations between High Protein Intake, Linear Growth, and Stunting in Children and Adolescents: A Cross-Sectional Study.

Childhood and adolescence are critical periods for linear growth and preventing stunting. Current evidence indicates that dietary protein intake in children and adolescents is often two to three times higher than the recommendations in many regions worldwide. However, few studies have focused on the association between high protein intake and linear growth and stunting in this population. We aim to investigate this association in children and adolescents aged 6 to 18 years in a population with relatively high protein consumption. We conducted a large cross-sectional study involving 3299 participants from Shenzhen, a modern metropolis of China. Protein intake, including total protein, animal protein, and plant protein, was evaluated by a food-frequency questionnaire and expressed as grams per kilogram of body weight per day (g·kg-1·d-1) and as a percentage of total energy intake (%E). The primary outcomes were body height and height-for-age Z score (HAZ). Generalized linear models and logistic regression analyses were employed to examine the associations between protein intake and outcomes. We also conducted stratified analyses across different genders and pubertal stages in the aforementioned associations. The mean protein intake was 1.81 g·kg-1·d-1 (17% E). After adjusting for serum calcium, zinc, vitamin D3, vitamin A levels, birth outcomes, lifestyle, and parental characteristics, each standard deviation increase of 1 in protein intake (0.64 kg-1·d-1) is found to be associated with a -5.78 cm change in body height (95% CI: -6.12, -5.45) and a -0.79 change in HAZ (95% CI: -0.84, -0.74). Consistent results were observed when protein intake was expressed as %E or specifically as animal or plant protein. Moreover, the relationship between protein intake and linear growth remained consistent across genders in different pubertal stages, similar to that of the overall participants. Our findings highlight the potential hazards of high protein intake on linear growth in children and adolescents. Caution should be exercised when promoting increased protein consumption in children and adolescents who already have a high intake of protein.

Intestinal flora and linear growth in children.

The gut microbiota plays a critical role in human growth and development as well as the regulation of human pathophysiological processes. According to research, the gut microbiota controls the host's growth and development in areas such as nutrition, metabolism, endocrine hormones, and immune modulation. The human gut microbiota has an important role in child and adolescent growth, especially when nutritional conditions are poor. In this review, we focus on recent findings about the gut microbiota's influence on child growth, including the relationship between the gut microbiota and linear growth during pregnancy, infancy, childhood, and adolescence. Furthermore, we also review some mechanisms by which intestinal flora influence the host's linear growth. Although the data supports a link between intestinal flora and linear development in children, our review has limitations that prohibit us from fully verifying the causal relationship between gut flora and linear development in children. Improving the gut microbiota, in conjunction with renutrition techniques, has the potential to ameliorate the growth and development impairments currently associated with chronic illness and malnutrition in children.

Effect of recombinant human growth hormone on serum Klotho and fibroblast growth factor 23 in children with idiopathic short stature

To investigate the changes in the serum levels of Klotho, fibroblast growth factor 23 (FGF23), and insulin-like growth factor-1 (IGF-1) in children with idiopathic short stature (ISS) before and after recombinant human growth hormone (rhGH) treatment, as well as the correlation of Klotho and FGF23 with the growth hormone (GH)/IGF-1 growth axis in these children. A prospective study was conducted on 33 children who were diagnosed with ISS in the Department of Pediatrics, Hebei Provincial People's Hospital, from March 10, 2021 to December 1, 2022 (ISS group). Twenty-nine healthy children, matched for age and sex, who attended the Department of Child Healthcare during the same period, were enrolled as the healthy control group. The children in the ISS group were treated with rhGH, and the serum levels of Klotho, FGF23, and IGF-1 were measured before treatment and after 3, 6, and 9 months of treatment. A correlation analysis was conducted on these indexes. There were no significant differences in the serum levels of IGF-1, Klotho, and FGF23 between the ISS and healthy control groups (P>0.05). The serum levels of Klotho, FGF23, and IGF-1 increased significantly in the ISS group after 3, 6, and 9 months of rhGH treatment (P<0.05). In the ISS group, Klotho and FGF23 levels were positively correlated with the phosphate level before treatment (P<0.05). Before treatment and after 3, 6, and 9 months of rhGH treatment, the Klotho level was positively correlated with the IGF-1 level (P<0.05), the FGF23 level was positively correlated with the IGF-1 level (P<0.05), and the Klotho level was positively correlated with the FGF23 level (P<0.05), while Klotho and FGF23 levels were not correlated with the height standard deviation of point (P>0.05). The rhGH treatment can upregulate the levels of Klotho, FGF23, and IGF-1 and realize the catch-up growth in children with ISS. Klotho and FGF23 may not directly promote the linear growth of children with ISS, but may have indirect effects through the pathways such as IGF-1 and phosphate metabolism. The consistent changes in Klotho, FGF23 and IGF-1 levels show that there is a synergistic relationship among them in regulating the linear growth of ISS children.

Correlation between gut microbiota composition, enteric infections and linear growth impairment: a case–control study in childhood stunting in Pidie, Aceh, Indonesia

BackgroundGut microbiota is pivotal in maintaining children's health and well-being. The ingestion of enteric pathogens and dysbiosis lead to Environmental Enteric Dysfunction (EED), which is essential in stunting pathogenesis. The roles of gut microbiome and enteric infections have not been explored comprehensively in relation to childhood stunting in Indonesia. This study aimed to determine the correlation between gut microbiota composition, enteric infections, and growth biomarker, Insulin-like Growth Factor 1 (IGF-1), in stunted children from Pidie, Aceh, Indonesia.MethodsThis study was a case–control study involving 42 subjects aged 24 to 59 months, comprising 21 stunted children for the case and 21 normal children for the control group. The IGF-1 serum level was quantified using ELISA. The gut microbiome profiling was conducted using 16S rDNA amplicon sequencing. The expression of enteric pathogens virulence genes was determined using quantitative PCR (qPCR) assay. The correlations of observed variables were analysed using suitable statistical analyses.ResultsThe result showed that the IGF-1 sera levels in stunted were lower than those in normal children (p ≤ 0.001). The abundance of Firmicutes (50%) was higher than Bacteroidetes (34%) in stunted children. The gut microbiome profile of stunted children showed enriched genera such as Blautia, Dorea, Collinsella, Streptococcus, Clostridium sensu stricto 13, Asteroleplasma and Anaerostipes. Meanwhile the depleted genera comprised Prevotella, Lactococcus, Butyrivibrio, Muribaculaceae, Alloprevotella, Akkermansia, Enterococcus, Terrisporobacter and Turicibacter. The abundance of water biological contaminants such as Aeromonas, Stappiaceae, and Synechococcus was also higher in stunted children compared to normal children. The virulence genes expression of Enteroaggregative Escherichia coli (aaiC), Enterotoxigenic E. coli (estA), Enteropathogenic E. coli (eaeA), Shigella/Enteroinvasive E. coli (ipaH3) and Salmonella enterica (ompC) in stunted was higher than in normal children (p ≤ 0.001), which negatively correlated to height and level of IGF-1.ConclusionThe present study showed the distinctive gut microbiome profile of stunted and normal children from Pidie, Aceh, Indonesia. The gut microbiota of stunted children revealed dysbiosis, comprised several pro-inflammatory, metabolic abnormalities and high-fat/low-fiber diet-related taxa, and expressed virulence genes of enteric pathogens. These findings provide evidence that it is imperative to restore dysbiosis and preserve the balance of gut microbiota to support linear growth in children.

Kejadian Stunting Berdasarkan Jenis Kelamin Dan Usia Di Wilayah Kerja Puskemas Kalisat

Stunting is a chronic condition characterized by the poor condition of the child or the inhibition of the child's linear growth due to the accumulation of various factors that occur over a long time. This situation can be seen based on the z-score of height according to age less than -2 standard deviation (SD) which is classified as short and very short. To find out the incidence of stunting by gender and age in the working area of the Kalisat Health Center in 2020. Descriptive research using secondary data from patient KIA data in February 2020. From the research that has been done, it can be concluded that the incidence of stunting in toddlers is mostly male and toddlers aged 24-36 months.

Trends and long-term variation explaining nutritional determinants of child linear growth: analysis of Bangladesh Demographic and Health Surveys 1996-2018.

To examine the height-for-age z-score (HAZ) of 0-35 months' children along with stunting prevalence to identify trends, changes and available nutrition-sensitive and specific determinants that could help explain the long-term variation in child linear growth using successive Bangladesh Demographic and Health Surveys (BDHS) data from 1996 to 2018. The BDHS pooled data are used for determining the key outcome variables HAZ, stunting and severe stunting. Trends, kernel-weighted local polynomial smoothing illustrations, pooled multivariable linear probability model (LPM), ordinary least squares method (OLS) and regression decomposition were used. Mothers having 0-35 months' children, the most critical age range for growth faltering. The mean HAZ increased by 0·91(±1·53) with 0·041 annual average change, while the percentages of stunting (-26·63 ± 0·54) and severe stunting (-21·12 ± 0·48) showed a reduction with 1·21 and 0·96 average annual changes, respectively. The average HAZ improvement (0·42 ± 1·56) in urban areas was less than the rural areas (1·16 ± 1·44). Similar patterns followed for stunting and severe stunting. The prenatal doctor visits (3064·65 %), birth in a medical facility (1054·32 %), breastfeeding initiation (153·18 %) and asset index (144·73 %) demonstrated a huge change. The findings of OLS, LPM and regression decomposition identified asset index, birth order, paternal and maternal education, bottle-fed, prenatal doctor visit, birth in a medical facility, vaccination, maternal BMI and ever-breastfed as influencing factors to predict the long-term changes of stunting and severe stunting. The nutrition-sensitive and specific factors identified through regression decomposition describing long-term variation in child linear growth should be focused further to attain the sustainable development goals.

Assessment of clinical impact of SARS-CoV-2 in people with type 1 diabetes: A cohort study

ObjectivesDuring the coronavirus 2019 pandemic, there had been more than 758 million COVID-19 cases as of February 13, 2023, and it is the main cause of death in many countries. Due to the variation in disease presentation, scientists determined that people living with type 2 diabetes mellitus were at higher risk of mortality. However, people living with type 1 diabetes have not been thoroughly studied, especially in extreme regions of developing countries. The objective of this study was to analyze the effects of SARS-CoV-2 pandemic restrictions on different variables in a cohort with type 1 diabetes. MethodsThis cohort-type study included pediatric and adult patients with type 1 diabetes at Regional Hospital Dr. Juan Noé Crevani in Arica, Chile. Biosocial and anthropometric factors, clinical history, self-care activities, and biochemical parameters were assessed and compared using analysis of variance and paired t tests between March 2020 and March 2021. ResultsA total of 150 patients were assessed during the SARS-CoV-2 pandemic in Arica, Chile. One year after the pandemic struck, the main causes for metabolic deterioration were a reduction of carbohydrate counting by an average of 8.67% (P = 0.000), a reduction of adherence to treatment by an average of 25% (P = 0.000), and a shift to telemedicine as a main health care service (P = 0.023); these factors raised hemoglobin A1c (HbA1c) levels by 1.81%, 1.78% and 0.075%, respectively. The participants’ average body mass index (BMI) increased by 1.26 kg/m2 and HbA1c levels increased by 0.16% during the first year of the pandemic. Also, hospitalizations increased about 2% (P = 0.984), and there was a significant increase in carbohydrate and snack intake (P = 0.330 and P = 0.811, respectively). Children's linear growth decreased by a standard deviation of 0.035 (P = 0.648), and their physical activity decreased by 12.67% (P = 0.383). ConclusionsThis study found that adherence to diabetes care was reduced during the pandemic owing to a variety of behavioral reasons and environmental changes (e.g., quarantines and food security). This affected this population's HbA1c levels, BMI, linear growth, and number of hospitalizations as main consequences. Telemedicine remains an important tool, but it must be reconsidered among all different age groups.

Efikasi Intervensi Suplementasi Zat Gizi terhadap Pencegahan Stunting pada Anak Usia &lt; 5 tahun - Studi Literatur

Stunting is a chronic nutritional problem in children under five whose nutritional status is measured based on height for age. One of the efforts to prevent stunting is through intervention or nutritional supplementation. In this review, we will discuss some of the efficacy of supplementation interventions in children under 5 years of age as an effort to reduce the incidence of stunting. This literature review was carried out through a search for journals on the PubMed database in the last 10 years (2011-2021) which resulted in 15 journals that fall into the inclusion criteria in this review. The results of the review show that there are 4 nutritional supplementation intervention methods applied to children under 5 years, including zinc supplementation, LNS supplementation (Lipid-Based Nutrient Supplements), MNP supplementation (Micronutrient Powder) and vitamin D supplementation. Zinc and MNP supplementation interventions, the results showed that there was no effect between the intervention group and the control group on the incidence of stunting or linear growth in children. While the LNS supplementation method, the majority of journals show that there is a significant effect on reducing the incidence of stunting in children. This is because LNS is a supplementation product that combines macro and micro nutrients so that the handling of stunting or for prevention is more optimal. This literature study conclude intervention that has high efficacy in reducing the incidence of stunting is LNS supplementation.

Social-Cultural Relationship with Stunting Incidence in Children Aged 24-59 Months

Stunting is a chronic condition of poor linear growth in children. The prevalence of stunting in Indonesia in 2018 reached 30.8%. With the complexity of the causes of stunting, one of the efforts being campaigned by the government is using local food. This study aimed to determine and analyze the influence of local food culture on preventing and overcoming stunting in toddlers (6-59 months) in Indonesia. The method used in this study is a systematic review based on the PRISMA guidelines. The results of this study show that a review of the seven selected journals shows that local food culture influences improving the nutritional status of toddlers, especially during the stunting prevention phase. Whereas in the prevention phase, local food culture by utilizing processed food forms has not improved the nutritional status of toddlers already suffering from stunting. Local food for toddlers who suffer from stunting must be accompanied by other supplements to have a significant effect. Food and eating in the community have cultural and social values, so the utilization of local food culture for toddler food will be easily accepted, easy to obtain, and affordable, significantly influencing stunting prevention in the regions. This research has implications for the importance of remembering that the results of this research can make a valuable contribution to the health and development of children in Indonesia and inspire concrete action to prevent funds from overcoming stunting.

When did the substantial loss of child linear growth occur?

Epidemiological studies show that the height-for-age Z-scores (HAZ) falter dramatically shortly after birth until the end of the first two years. Understanding these changes in linear growth in the first two years can help us understand the critical period of child linear growth and propose interventions. This study objectives were to describe the pattern of linear growth faltering and analyze the changes in length-for-age Z-scores (LAZs) throughout the first two years based on birthweight and length status. This study analyzed 408 children, participants in Longitudinal Study on Child Growth and Development in Bogor, Indonesia. The linear growth pattern was described based on birthweight and length status. Birthweight and length status was categorized into normal and Small for Gestational Age (SGA). Changes in LAZs (Δ LAZs) in 0-6 months, 6-12 months, and 12-23 months were calculated. General Linear Model Univariate analysis was conducted to analyze the difference of Δ LAZ between SGA and normal children. Though full-term SGA children have significantly higher linear growth velocity during the first 6 months of the infancy period, full-term SGA children could not catch up with the attained growth/height of normal children throughout the first two years. Thus, full-term SGA children ended up with a higher prevalence of stunted. Both in SGA and normal children, the substantial loss of LAZ occurred between 0-6 months. The finding in this study showed that the first 1000 days of life is still the best period in stunting prevention; however, the stunting prevention program should start earlier, focusing on the first 500 days of life, and potentially the prenatal period.

Impact of maternal education on the growth of children in a patriarchy

Aim: To assess the association of father’s education and occupation with children growth measured by height-for-age z-scores and BMI-for-age z-scores in a patriarchal culture where father’s social position is considered more important than mother’s social position. Sample and methods: The present cross-sectional study consists of 387 school-going girls aged 9-14 years residing in Matigara, Siliguri sub-division of Darjeeling district, West Bengal, India. Information on age, mother’s education, father’s education, ethnic affiliation, mother’s occupation, father’s occupation, house type, household monthly income and family size were recorded. Associations between variables were assessed using Spearman correlation, St. Nicolas house analysis (SNHA), and one-way analysis of variance (ANOVA) with box plots. Results: The hypothesis that in a patriarchy paternal socio-economic status (SES) influences children growth more than maternal SES was not supported. The observed correlation between mother education and measure of growth (BAZ and HAZ) was, 0.15 and 0.13, respectively. SNHA showed direct connection between HAZ of girls and mother education. Further, using ANOVA significant difference in the HAZ of adolescents was observed between least educated mothers and moderately educated mothers (F = 6.593; p &lt; 0.01). No such difference between the maternal education levels was observed for BAZ. Conclusion: Maternal education is an important factor influencing children linear growth even in a patriarchy. The association was independent of nutrition. Common explanations are functional literacy, decision making, access to information and health infrastructure, and less domestic violence. Mother’s education may influence perceived future prospects of the daughters, and could be an important stimulus for growth.

P26-025-23 An Alternative Growth Metric To Assess the Effect of Small-Quantity Lipid-Based Nutrient Supplements on Child Linear Growth in Low- and Middle-Income Countries (LMICs)

P26-025-23 An Alternative Growth Metric To Assess the Effect of Small-Quantity Lipid-Based Nutrient Supplements on Child Linear Growth in Low- and Middle-Income Countries (LMICs)

The association between complementary feeding practice and linear growth faltering among Cambodian children: an analysis of the 2014 Cambodia Demographic and Health Survey

Background Inappropriate complementary feeding is a factor contributing to linear growth faltering in early childhood. We aimed to assess complementary feeding practice and investigate its association with linear growth faltering among children aged 6 to 23 months among children aged 6-23 months in Cambodia. Methods This study is a secondary data analysis of the 2014 Cambodia Demographic and Health Survey (CDHS). Multivariable linear regression analysis was used to investigate associations between complementary feeding practice and linear growth faltering as length-for-age z-scores (LAZ), adjusted for all covariates. Results This study included 1381 children aged 6 to 23 months. The prevalence of age-appropriate complementary feeding practice was low in Cambodia. Only 23% of the children met all three criteria of minimum dietary diversity, minimum meal frequency, and age-appropriate breastfeeding. Approximately 30% of children aged 6 to 11 months met the minimum dietary diversity requirements and less than 40% of children aged 18 to 23 months were provided breastfeeding after the introduction of complementary food. This study found that there is no relationship between food diversity and feeding frequency and child linear growth. However, the provision of both complementary food and breast milk was independently and negatively associated with linear growth (β-Coefficient=-0.38, 95% confidence interval, CI=-0.60, -0.16). Positive effects on child linear growth, after controlling for all covariates, included the richer (β-Coefficient=0.36, 95% CI=0.07, 0.66) and richest (β-Coefficient=0.50, 95% CI=0.20, 0.79) quintiles of households, as well as appropriate water treatment before drinking (β-Coefficient=0.22, 95% CI=0.05, 0.40). Conclusions Most Cambodian young children aged 6 to 23 months received inappropriate complementary feeding. This study suggests that from the time of conception there is a necessity to improve maternal and child nutrition educational intervention for mothers, including feeding and hygiene practices.

Analyzing determinants from both compositional and contextual level impeding desired linear growth of children in Indian context

Childhood stunting is recognized as significant public health concern in India. It is a form of malnutrition with impaired linear growth and creates a range of adversaries among children, including under-5 mortality, morbidity, and physical and cognitive growth. The purpose of the present study was to recognize the various leading determinants causing childhood stunting from both individual and contextual level in Indian context. Data were obtained from the India’s Demography and Health Survey (DHS) conducted in 2019–2021. A total of 1, 46,521 children aged 0–59 months were included in this present study. The study applied a multilevel mixed-effect logistic regression model in which individual factors nested within community based contextual-level factors estimating the likelihood of childhood stunting phenomena among Indian children. The variance explained in full model accounted for about 35.8% of the odds of stunting across the communities. The present study elucidates that the recognized factors from individual level characteristics have really increased the odds of childhood stunting: gender of child, multiple births, low birth weight, low BMI among mothers, less educational attainment by mothers, maternal anemic status, breast feeding duration longer than usual, < 4 antenatal care (ANC) visits during gestation period. Similarly, contextual-level factors like rural places of residence, western Indian children, and communities with high poverty rates, lower literacy rates, improper sanitation, and unsafe drinking water were also found to have a significant positive association with childhood stunting. The study finally concludes that cross level interaction between individual and contextual-level factors are identified as significant determinants of linear growth retardation among child in India. In order to reduce this type of malnutrition among the child one should more concentrate on both individual and contextual-level factors as a notable reasons.

Calcium and Vitamin D Supplementation to Improve Linear Growth in Children

In India, the prevalence of vitamin D deficiency as assessed by vitamin D levels below 20 ng/ml is high across the country, in all socio-economic, age and sex groups. Studies from India have documented that prevalence of vitamin D deficiency is high in breast-fed infants. Stunting in young children continues to be a major public health problem in India. It is possible that in addition to low birth weight and chronic energy deficiency, vitamin D deficiency may contribute to the high stunting rates in breast-fed Indian children. If this were so, vitamin D supplementation may reduce the magnitude of linear growth retardation in the first two years of life. A community-based randomised, double-blind supervised daily supplementation of 250 mg of calcium and 250 IU of Vitamin D (Group A) or placebo (Group B) to breast-fed infants from the first month up to 23 months of age was undertaken to assess the impact, if any, of vitamin D supplementation on linear growth in children and height attained at 23 months. At enrolment, there were no significant differences in weight, length and BMI between infants belonging to Group A or Group B. There were no significant differences in infant and young child feeding practices, morbidity due to infection, or linear growth and height attained at 23 months between Group A and Group B. These data suggest that daily supplementation of calcium and vitamin D between 0-23 months did not have any significant impact on linear growth of children from urban low middle income families.

Effectiveness of Food-Based Intervention to Improve the Linear Growth of Children under Five: A Systematic Review and Meta-Analysis.

Food-based interventions to improve linear growth are most often applied in low- and middle-income countries. However, not all food interventions have been proven to be effective in promoting linear growth. This study aimed to assess the impact and effectiveness of food interventions for improving linear growth in children under five years old. This study was conducted by following the PRISMA guidelines and the data were extracted and presented following the PRISMA recommendations. Studies were identified through a literature search of the SCOPUS, Web of Science, PubMed, ScienceDirect, and ProQuest databases from 2000 to 2022. Only randomized control studies were included in this review based on the inclusion and exclusion criteria. Out of 1125 studies identified, a total of 15 studies were included in this systematic review and meta-analysis. The review result indicated that food-based intervention can help to improve linear growth (MD: 0.20, 95% CI: 0.04 to 0.35, p = 0.01) among children under five. However, there was no significant difference in changes in underweight status (MD: 0.25; CI: -0.15 to 0.64; p = 0.22) and wasting status (MD: 0.09; CI: -0.02 to 0.20; p = 0.12) between the intervention and control groups. Overall, food-based interventions were found to be helpful for improving children's linear growth.

Potential impact and cost-effectiveness of Shigella vaccination in 102 low-income and middle-income countries in children aged 5 years or younger: a modelling study

Vaccine impact and cost-effectiveness models have mostly focused on acute burden. Shigella-attributable moderate-to-severe diarrhoea has been shown to be associated with childhood linear growth faltering. Evidence also links less severe diarrhoea to linear growth faltering. As Shigella vaccines are in late stages of clinical development, we aimed to estimate the potential impact and cost-effectiveness of vaccination against Shigella burden that includes stunting and the acute burden attributable to less severe diarrhoea and moderate-to-severe diarrhoea. We used a simulation model to estimate Shigella burden and potential vaccination in children aged 5 years or younger from 102 low-income to middle-income countries from 2025 to 2044. Our model included stunting associated with Shigella-related moderate-to-severe diarrhoea and less severe diarrhoea and we explored vaccination impact on health and economic outcomes. We estimate 109 million (95% uncertainty interval [UI] 39-204) Shigella-attributable stunting cases and 1·4 million (0·8-2·1) deaths in unvaccinated children over 20 years. We project that Shigella vaccination could avert 43 million (13-92) stunting cases and 590 000 (297 000-983 000) deaths over 20 years. The overall mean incremental cost-effectiveness ratio (ICER) was US$849 (95% uncertainty interval 423-1575; median $790 [IQR 635-1005]) per disability-adjusted life-year averted. Vaccination was most cost-effective in the WHO African region and in low-income countries. Including the burden of Shigella-related less severe diarrhoea improved mean ICERs by 47-48% for these groups and substantially improved ICERs for other regions. Our model suggests that Shigella vaccination would be a cost-effective intervention, with a substantial impact in specific countries and regions. Other regions could potentially benefit upon the inclusion of the burden of Shigella-related stunting and less severe diarrhoea in the analysis. Bill & Melinda Gates Foundation and Wellcome Trust.

Complementary and alternative metrics for tracking population-level trends in child linear growth

Stunting prevalence is commonly used to track population-level child nutritional status. However, other metrics derived from anthropometric datasets may be used as alternatives to stunting or provide complementary perspectives on the status of linear growth faltering in low- and middle-income countries (LMICs). Data from 156 Demographic and Health Surveys in 63 LMICs (years 2000 to 2020) were used to generate 2 types of linear growth metrics: (i) measures of location of height distributions (including stunting) for under-5 years (<5y) and 2 to 5 years (2-5y); (ii) model-derived metrics including predicted mean height-for-age z-score (HAZ) at 0, 2, and 5 years; interval slopes of HAZ, height-for-age difference (HAD), and growth delay (GD) from 1 month to 2 years (1mo-2y) and 2-5y; and the SITAR intensity parameter (SITAR-IP) for <5y. Using Spearman's rank correlation coefficient (r), metrics were considered alternatives to stunting if very strongly correlated with stunting (|r|≥0.95) and at least as strongly correlated as stunting with selected population indicators (under 5y mortality, gross domestic product, maternal education). Metrics were considered complementary if less strongly correlated with stunting (|r|<0.95) yet correlated with population indicators. We identified 6 of 15 candidate metrics (stunting 2-5y, mean HAZ <5y and 2-5y, p25 HAZ <5y and 2-5y, predicted HAZ at 2y) as potential alternatives to stunting and 6 as complementary metrics (SITAR-IP, predicted HAZ at 5y, HAZ slope 1m-2y, HAD slope 1m-2y, GD slopes 1m-2y and 2-5y). Three metrics (HAZ slope 2-5y, HAD slope 2-5y years and predicted HAZ at birth) had weak correlations with population indicators (|r| ≤ 0.43). In conclusion, several linear growth metrics could serve as alternatives to stunting prevalence and others may be complementary to stunting in tracking global progress in child health and nutrition. Further research is needed to explore the real-world utility of these alternative and complementary metrics.