Linear Growth In Children Research Articles

Aflatoxin Exposure in Children Aged 4 Months to 5 Years from sub-Saharan Africa and its Effect on Stunted Child Growth – a Topical Review

The mould species fungi encompass among others the family of Aspergillus which produce and secrete a number of compounds toxic to human health, namely the aflatoxins. These mycotoxins are converted to secondary metabolites that exert the often detrimental biological effect, and they are commonly found in various foods such as fruits, nuts, seeds, and grains. Members of the Aspergillus family thrive in wet and humid conditions, so they are particularly prevalent in regions with a tropical climate, for example in countries in sub-Saharan Africa. Aflatoxins are a type of mycotoxins considered to be among the most known potent mutagenic and carcinogenic substances. For example, it can cause liver cancer. Importantly, aflatoxins often contaminate weaning foods consumed by small children. This topical review outlines the evidence on the associations between aflatoxin exposure and impaired linear growth (stunting, that is low height/length for age) in small children (aged 4 months to 5 years) from sub-Saharan Africa. Ten studies were retrieved from the database PubMed after considering predefined inclusion and exclusion criteria. Six out of the ten studies found a significant inverse association between increased aflatoxin exposure and stunted child growth. Although aflatoxin exposure and stunting prevalence were high and widespread in most of the included studies, in general, studies conducted in Western Africa had the highest aflatoxin exposure and stunting prevalence. The only included randomized controlled trial found that a diet aimed at reducing aflatoxin exposure significantly improved linear growth in children at 13, but not at 22, months of age. The evidence suggests that aflatoxins have an impact on linear growth among children aged 4 months to five years. Possibly there is a threshold value for aflatoxin exposure before a significant impact on growth can be identified. Raised awareness and management strategies for the high aflatoxin exposure rates in sub-Saharan Africa and its negative health effects, in particular stunted child growth, are warranted. Key words: Aflatoxin, children, diet, linear growth, stunting, sub-Saharan Africa, topical review

Maternal factors promoting normal linear growth of children from impoverished Rwandan households: a cross-sectional study

BackgroundLinear growth faltering remains a pervasive public health concern that affects many children worldwide. This study aimed to investigate possible maternal factors promoting normal linear growth among children aged 6–23 months of age from impoverished Rwandan households.MethodsWe used a three-stage cluster sampling procedure. The study population consisted of children aged six to 23 months and their mothers who lived in the study districts. A structured questionnaire helped to collect data from 807 selected mother-child dyads. The primary outcome variable was height-for-age Z scores. The main predictors were maternal income-generating activity, maternal education, maternal depression, household decision making, number of ANC visits, use of family planning method, types of family planning, and mode of delivery. We used univariate analysis to establish median, frequencies, and percentages. Furthermore, we used the Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation tests for bivariate analysis. We included in the final model of robust linear regression for multivariate analysis the potential confounding variables identified as significantly associated with the outcome (child age, participation in works for both parents, good handwashing practice, owning a vegetable garden, and the total number of livestock) along with maternal factors.ResultsMaternal factors that promoted normal linear growth of children were the presence of maternal income generation activity (β= 0.640 [0.0269 1.253], p value = 0.041), the participation of the mother in the decision-making process of the household (β=0.147 [0.080 0.214], p-value < 0.001), and the higher frequency of consultations with ANC (β=0.189 [0.025 0.354], p-value = 0.024). Additionally, a combination of household decision-making with the number of ANC visits predicted an increase in the linear growth of the child (β=0.032 [0.019 0.045], p-value < 0.001).ConclusionMaternal factors such as maternal income-generating activity, maternal participation in household decision making, and increased number of ANC visits were found to promote normal child linear growth. These results contribute valuable information to the formulation of interventions and policies to improve child nutrition and growth in the community studied.

The association between atopic dermatitis and linear growth in children- a systematic review.

To evaluate the association between atopic dermatitis (AD) and linear growth in children, and determine factors associated with compromised linear growth in children with AD. A PRISMA-compliant systematic review was conducted. Databases (PubMed, Embase, Scopus and Cochrane) were searched from inception to June 2024 for articles that reported a quantitative relationship between AD and linear growth in children (< 18years old). Quality of included articles was assessed using the Joanna Briggs Institute Critical Appraisal Tools while quality of evidence in these studies was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Fourteen studies (comprising 50,146 patients with AD) were included. Seven studies reported a strong positive or positive association between AD and reduced height standard deviation score (SDS) in children; the others reported no association. Only 3 studies had moderate quality of evidence, all of which reported an association between AD and poorer height SDS; the remaining 11 studies scored low in quality of evidence. Three studies reported the impact of AD on height to be transient. Secondary analysis showed AD severity, earlier AD onset, sleep disruption and, food restriction, to be risk factors for linear growth impairment in patients with AD. Topical steroid use was not associated with shorter stature in patients with AD. Conclusion: Current evidence on the association between childhood AD and poor linear growth is weak and inconsistent. However, patients with more severe AD, earlier disease onset, poorer sleep quality and higher nutritional restrictions appear more susceptible to linear growth impairment. What is known? • There is inconsistent evidence of the association between atopic dermatitis (AD) and linear growth in children in current literature, with some studies suggesting that AD may negatively impact linear height while other studies do not report similar associations. What is new? • There is no strong association between AD in childhood and poorer linear growth. • There may be a transient slowing of linear growth in children with AD, mimicking constitutional growth delay. • Children with severe AD, earlier disease onset, poorer sleep quality and nutritional restrictions may be at risk of more significant linear growth impairment. • Topical steroid use does not appear to contribute to shorter height in children with AD.

9267 Targeting IGF-I to Growth Plate Cartilage Augments Therapeutic Effects on Skeletal Growth and Reduces Hypoglycemic Effects in Mice

Abstract Disclosure: K. Tailor: None. T. Stowe: None. J. Ree: None. B. Ventura: None. J. Deursen: None. R. O'Brien: None. J. Baron: None. J. Lui: None. Recombinant human growth hormone (GH) is commonly used to treat short stature in children but has limited efficacy in severe, non-GH-deficient conditions, such as skeletal dysplasias, and has adverse off-target effects. Because short stature is the result of reduced growth plate chondrogenesis, we hypothesized that targeting chondrogenic growth factors specifically to the growth plate might augment the therapeutic skeletal effect while diminishing adverse effects on non-target tissues. Toward this end, we previously developed fusion proteins conjugating insulin-like growth factor-1 (IGF-1) with a single-chain human monoclonal antibody fragment (ScFv) targeting matrillin-3 (1), a protein specifically expressed in cartilage matrix, and demonstrated increased on-target therapeutic efficacy at the growth plate and decreased off-target effects in a GH-deficient (lit) mouse model (2). In the current study, we established a second GH-deficiency model by administration of a GH antagonist, pegvisomant (PEG), in C57BL/6 wild-type male mice. Alternate-day injection of pegvisomant at 40 mg/kg for 7 days reduced body weight, serum IGF-1 levels, and growth plate height in mice. Using this model, we found that once-daily SQ administration of cartilage-targeted IGF-I (named CV1574-1) for five days increased body weight and growth plate height greater than an equimolar dose of IGF-I itself administered twice daily. Hypoglycemia is an adverse effect of recombinant IGF-1 treatment. Therefore, we also monitored blood glucose levels after a single SQ injection of CV1574-1 and found that this fusion protein showed a reduced hypoglycemic effect compared to injection of IGF-I itself. Lastly, to gain mechanistic insight into the role of matrillin-3 targeting on therapeutic efficacy, we assessed the ability of CV1574-1 to induce pAKT signaling in vitro. Transient exposure to CV1574-1 caused more prolonged induction of pAKT signal in wild-type rat chondrosarcoma (RCS) cells compared to matrillin-3-knockout RCS cells, suggesting that matrillin-3 targeting extends the duration of IGF-1 receptor activation. To summarize, the current findings demonstrate that CV1574-1, a fusion protein that targets IGF-1 to cartilage, improves efficacy at the growth plate, reduces hypoglycemic effects, and, in vitro, prolongs receptor activation. Our study provides further evidence that cartilage-targeted therapy has the potential to provide new pharmacological approaches for the treatment of childhood linear growth disorders, including skeletal dysplasias and growth failure due to systemic disease. Reference:(1) Cheung et al. Pharma Res 2015, 32(7):2439-49.(2) Lui et al. Molecular Therapy 2019, 27(3):673-680 Presentation: 6/3/2024

7237 Targeting IGF-I to Growth Plate Cartilage Augments Therapeutic Effects on Skeletal Growth and Reduces Hypoglycemic Effects in Mice

Abstract Disclosure: K. Tailor: None. T. Stowe: None. J. Ree: None. B. Ventura: None. J. Deursen: None. R. O'Brien: None. J. Baron: None. J. Lui: None. Recombinant human growth hormone (GH) is commonly used to treat short stature in children but has limited efficacy in severe, non-GH-deficient conditions, such as skeletal dysplasias, and has adverse off-target effects. Because short stature is the result of reduced growth plate chondrogenesis, we hypothesized that targeting chondrogenic growth factors specifically to the growth plate might augment the therapeutic skeletal effect while diminishing adverse effects on non-target tissues. Toward this end, we previously developed fusion proteins conjugating insulin-like growth factor-1 (IGF-1) with a single-chain human monoclonal antibody fragment (ScFv) targeting matrillin-3 (1), a protein specifically expressed in cartilage matrix, and demonstrated increased on-target therapeutic efficacy at the growth plate and decreased off-target effects in a GH-deficient (lit) mouse model (2). In the current study, we established a second GH-deficiency model by administration of a GH antagonist, pegvisomant (PEG), in C57BL/6 wild-type male mice. Alternate-day injection of pegvisomant at 40 mg/kg for 7 days reduced body weight, serum IGF-1 levels, and growth plate height in mice. Using this model, we found that once-daily SQ administration of cartilage-targeted IGF-I (named CV1574-1) for five days increased body weight and growth plate height greater than an equimolar dose of IGF-I itself administered twice daily. Hypoglycemia is an adverse effect of recombinant IGF-1 treatment. Therefore, we also monitored blood glucose levels after a single SQ injection of CV1574-1 and found that this fusion protein showed a reduced hypoglycemic effect compared to injection of IGF-I itself. Lastly, to gain mechanistic insight into the role of matrillin-3 targeting on therapeutic efficacy, we assessed the ability of CV1574-1 to induce pAKT signaling in vitro. Transient exposure to CV1574-1 caused more prolonged induction of pAKT signal in wild-type rat chondrosarcoma (RCS) cells compared to matrillin-3-knockout RCS cells, suggesting that matrillin-3 targeting extends the duration of IGF-1 receptor activation. To summarize, the current findings demonstrate that CV1574-1, a fusion protein that targets IGF-1 to cartilage, improves efficacy at the growth plate, reduces hypoglycemic effects, and, in vitro, prolongs receptor activation. Our study provides further evidence that cartilage-targeted therapy has the potential to provide new pharmacological approaches for the treatment of childhood linear growth disorders, including skeletal dysplasias and growth failure due to systemic disease. Reference:(1) Cheung et al. Pharma Res 2015, 32(7):2439-49.(2) Lui et al. Molecular Therapy 2019, 27(3):673-680 Presentation: 6/3/2024

Mechanisms linking prenatal environment and linear growth: the case of Ramadan during pregnancy.

Despite established links between prenatal nutritional deprivation and impaired offspring growth, the underlying dynamics and potential moderators remain largely unexplored. This study investigates the dynamics underlying Ramadan during pregnancy and its associations with children's linear growth, using data from the Indonesian Family Life Survey (1993 - 2015). We exploit Ramadan during pregnancy as a natural experiment, separating exposure from maternal background characteristics and season of birth effects. Employing OLS and logistic regressions, we explore two key mechanisms predicted by medical theory. First, the realization of health impairments in response to prenatal shocks is influenced by postnatal circumstances. Our results reveal significant growth impairments primarily in children raised under poor sanitary conditions, which is a risk factor for diminished linear growth by itself. Secondly, we assess whether prenatal Ramadan prompts epigenetic shifts towards earlier reproductive activity, potentially at the expense of height growth. Our data shows that prenatally exposed women tend to have their first childbirth at a younger age, though menarche onset remains unaffected. These results suggest that postnatal environments play a crucial role in mitigating sensitivity to prenatal shocks, highlighting the critical need for favorable living conditions for all children.

The Effect of Rainfall and Temperature Patterns on Childhood Linear Growth in the Tropics: Systematic Review and Meta-Analysis.

Despite existing research on child undernutrition in the tropics, a comprehensive understanding of how weather patterns impact childhood growth remains limited. This study summarizes and estimates the effect of rainfall and temperature patterns on childhood linear growth among under-fives in the tropics. A total of 41 out of 829 studies were considered based on preset inclusion criteria. Standardized regression coefficients (β) were used to estimate effect sizes, which were subsequently pooled, and forest plots were generated to visually represent the effect size estimates along with their 95% confidence intervals. Of the total reports, 28 and 13 research articles were included in the narrative synthesis and meta-analysis, respectively. The studies establish that patterns in rainfall and temperature either increase or decrease childhood linear growth and the risk of stunting. An increase in every one standard deviation of rainfall results in a 0.049 standard deviation increase in linear growth (β = 0.049, 95% CI: 0.024 to 0.073). This positive association is likely mediated by various factors. In countries where agriculture is heavily dependent on rainfall, increased precipitation can lead to higher crop yields which could in turn result in improved food security. The improved food security positively impacts childhood nutrition and growth. However, the extent to which these benefits are realized can vary depending on moderating factors such as location and socio-economic status. Temperature pattern showed a negative correlation with linear growth, where each standard deviation increase resulted in a decrease in linear growth by 0.039 standard deviations, with specific impacts varying by regional climates (β = -0.039, 95% CI: -0.065 to -0.013). Additionally, our meta-analysis shows a small but positive relationship of childhood stunting with temperature pattern in western Africa (β = 0.064, 95% CI: 0.035, 0.093). This association is likely due to temperature patterns' indirect effects on food security and increased disease burden. Thus, the intricate interaction between weather patterns and childhood linear growth requires further research to distinguish the relationship considering other factors in the global tropics. While our findings provide valuable insights, they are primarily based on observational studies from sub-Saharan Africa and may not be generalizable to other tropical regions.

Association of nighttime sleep duration at 1.5 years with height at 3 years: The Japan Environment and Children's Study.

Adequate nighttime sleep duration has been considered beneficial for linear growth in children; however, there is limited and conflicting evidence regarding the association between sleep duration and subsequent linear growth. To investigate the association between sleep duration at 1.5 years and height at 3 years of age. The Japan Environment and Children's Study is a nationwide prospective birth cohort study. Data from 52,140 term singleton births born at an appropriate-for-gestational age without background disorders that could potentially affect linear growth in the analyses were included. Nighttime and total sleep durations were calculated based on a self-administered questionnaire completed by caregivers. Tall stature was defined as height at or above the 75th percentile among participants. After adjustment for height at 1.5 years, sex, monthly age, mother's height, presence of siblings at 1.5 years, environmental tobacco smoke at 1.5 years, daily TV/DVD screen time at 2 years, attendance at nursery at 2 years, household annual income at birth, and parents' educational status, multivariate odds ratio (95% confidence interval) for tall stature at 3 years were 1.09 (1.01-1.17), 1.09 (1.01-1.17), and 1.25 (1.14-1.37) for 9.5 or 10, 10.5 or 11, and ≥ 11.5 h of nighttime sleep duration at 1.5 years, respectively, compared with those with ≤ 9 h sleep (p for trend <0.0001). Total sleep duration was not associated with tall stature. This study underscores the importance of nighttime sleep duration, not total sleep duration, in the linear growth of very young children.

Impact of Nutrition Supplementation on linear growth among 12–18 months children of Belagavi city: A randomized control trial

BackgroundAdequate nutrition is one of the most important factors influencing growth & immunity. Bovine colostrum (BC) is the first milk produced after birth of a calf and is a rich natural source of macronutrients, micronutrients, immunoglobulins, growth factors and peptides with anti-microbial activity. ObjectiveThe current study was conducted to test the hypothesis whether BC supplementation would lead to an increase in linear growth of children of age 12–18 months. The secondary objectives were 1) To measure biomedical parameters among 12–18 months children in the 2 groups, i.e., BC and control group. 2) To assess the acceptability and tolerability of BC among children. Materials & methodsA double blinded randomized control trial was conducted among children in the age group of 12–18 months. A total of 78 participants were included and were randomly divided into experiment and control groups. Anthropometric measurements and biochemical parameters were measured before and after intervention. The acceptability and tolerability of BC was assessed through a questionnaire filled by the mothers of study participant. ResultsThere was a significant difference observed in Body mass index (BMI), Chest circumference and Mid upper arm circumference in the BC group but there was not any significant difference found in biochemical parameters. Mothers of study participant reported high acceptability and no side effects of the intervention. ConclusionSupplementation of BC in children's diet lead to improved anthropometric outcomes in children of Belagavi city and was acceptable by them.

Identification of Enteric Pathogen Reservoirs and Transmission Pathways Associated with Short Childhood Stature in the Kolkata Indian Site of the Global Enteric Multicenter Study.

Age-stratified path analyses modeled associations between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) to identify determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS). Models tested direct associations of potential pathogen reservoirs with HAZ at 60-day follow-up in separate moderate and severe diarrhea (MSD) case and control cohorts or indirectly when mediated by enteric infections. In the MSD cohort, rotavirus and typical EPEC (tEPEC) infections among children 0-11 months of age and ST-ETEC infections among children 12-23 months of age were associated with lower HAZ. Handwashing after defecating and before cooking reduced impaired growth through reductions in rotavirus and tEPEC infections. Water storage increased rotavirus and ST-ETEC infection risks, resulting in increased impaired growth, but was reduced with reported child feces disposal. The GII norovirus variant was inversely associated with HAZ among children 12-59 months of age in the control cohort. Reported handwashing before the handling of children reduced GII infections and impaired growth. Boiling water and the disposal of children's feces mediated by stored water were positively associated with HAZ. The targeting of pathogen-specific reservoirs and transmission pathways may more effectively improve childhood linear growth in South Asian urban communities.

Serum calcium as a candidate marker in detecting stunting in toddler

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Monitoring the nutritional status of toddlers is a very important thing to do. Calcium is one of the blood parameters that can be assessed, because calcium deficiency will affect the child's linear growth. So far, monitoring of nutritional status is only based on anthropometry and is not followed by assessment of blood parameters. &lt;/em&gt;&lt;strong&gt;&lt;em&gt;Objectives:&lt;/em&gt;&lt;/strong&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This study aims to measure serum calcium levels as a candidate marker in detecting stunting in toddlers. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Method:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; The design of this research is cross sectional with 62 samples of toddlers aged 2-5 years. Data on sample characteristics was obtained through a questionnaire, as for serum calcium levels measurement, venous blood samples were taken and measured with the colorimetric method. The incidence of stunting is obtained based on TB/U measurements and Z-score was calculated using Anthro 1.02 software. Data were then analyzed univariately (frequency distribution) and bivariately (&lt;/em&gt;&lt;em&gt;independent t-test and &lt;/em&gt;&lt;em&gt;chi-square) using SPSS version 22. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Based on anthropometric measurements, it was found that 21 (33.9%) toddlers had stunting, 28 (45.1%) toddlers had low Serum calcium levels and the majority of toddlers (54.9%) had normal serum calcium levels. There was no significant difference (p=0.989) in mean serum calcium levels between stunting and non-stunting toddlers (1.961 ± 0.223 µq/dL vs 1.960 ± 0.175 µq/dL). Bivariate results also showed that there was no significant relationship (p=0.414) between serum calcium levels and the incidence of stunting. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusion:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Measuring serum calcium levels cannot be used as a candidate marker for detecting stunting in toddlers. Further research is needed with a larger number of samples and measurements of various parameters related to calcium balance.&lt;/em&gt;&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Linear growth in children and adolescents with congenital adrenal hyperplasia.

Congenital adrenal hyperplasia (CAH) is a relatively common disorder and one of the most challenging conditions seen by pediatric endocrinologists. Poor linear growth in CAH has been recognized for many years. There are new insights to explain this abnormality and shed light on strategies to promote normal growth. Published data suggest that the dose of hydrocortisone during two critical periods of rapid growth, namely infancy and at puberty, has a fundamental effect on growth velocity, and by definition adult height. To prevent over-treatment, hydrocortisone dosage should remain within the range of 10-15 mg/m 2 body surface area per day. Precursor steroids such as 17-hydroxy progesterone (17OHP) should not be suppressed to undetectable levels. In fact, 17OHP should always be measurable, as complete suppression suggests over-treatment. CAH is a challenging disorder. High-quality compliance within the consultation setting, with the patient seeing the same specialist at every visit, will be rewarded by improved long-term growth potential. Quality auxological monitoring can avoid phases of growth suppression. New therapy with CRH receptor antagonists may lead to a more nuanced approach by allowing fine tuning of hydrocortisone replacement without the need to suppress ACTH secretion.

Update on the use of long-acting growth hormone in children.

After extensive research and many years of waiting, long-acting growth hormone (LAGH) formulations have finally become a reality in clinical practice and emerge as a potential solution to address the challenges of daily injections of recombinant human GH (rhGH). In this review, we present a brief history of the development of LAGH and provide a critical analysis of the existing literature on the five LAGH available and approved to date for treatment in children. In clinical trials, LAGH therapy has shown noninferiority compared with daily rhGH therapy in promoting linear growth in children with GH deficiency, with similar rates of adverse events. In the real world, many questions still need to be answered, such as whether a specific group of patients will benefit most from the weekly injection, whether compliance will be better compared with daily rhGH, whether long-term efficacy, monitoring and safety profile will be the same for the different LAGH compounds, and whether the cost-effectiveness will justify their use in different settings.

Effects of maternal calcium supplementation on offspring blood pressure and growth in childhood and adolescence in a population with a low-calcium intake: follow-up study of a randomized controlled trial

BackgroundThe World Health Organization recommends calcium supplementation (1500–2000 mg/d) during pregnancy for women with a low-calcium intake. ObjectivesThe purpose of this study was to investigate whether pregnancy calcium supplementation affects offspring blood pressure and growth in The Gambia where calcium intakes are low (300–400 mg/d). MethodsFollow-up of offspring born during a randomized controlled trial of pregnancy calcium supplementation (ISRCTN96502494, 1996–2000) in which mothers were randomly assigned to 1500 mg Ca/d (Ca) or placebo (P) from 20 wk pregnancy to delivery. Offspring were enrolled at age 3 y in studies where blood pressure and anthropometry were measured under standardized conditions at approximately 2-yearly intervals. Mean blood pressure and growth curves were fitted for females and males separately, using the longitudinal SuperImposition by Translation and Rotation (SITAR) mixed effects model. This generates 3 individual-specific random effects: size, timing, and intensity, reflecting differences in size, age at peak velocity, and peak velocity through puberty relative to the mean curve, respectively. ResultsFive hundred twenty-three singleton infants were born during the trial (maternal group assignment: Ca/P = 259/264). Four hundred ninety-one were enrolled as children (females: F-Ca/F-P = 122/129 and males: M-Ca/M-P = 119/121) and measured regularly from 3.0 y to mean age 18.4 y; 90% were measured on ≥8 occasions. SITAR revealed differences in the systolic blood pressure and height curves between pregnancy supplement groups in females, but not in males. F-Ca had lower systolic blood pressure than F-P at all ages (size = −2.1 ± SE 0.8 mmHg; P = 0.005) and lower peak height velocity (intensity = −2.9 ± SE 1.1%, P = 0.009). No significant pregnancy supplement effects were seen for other measures. ConclusionsThis study showed, in female offspring, that pregnancy calcium supplementation may lower systolic blood pressure and slow linear growth in childhood and adolescence, adding to evidence of offspring sexual dimorphism in responses to maternal supplementation. Further research is warranted on the long-term and intergenerational effects of antenatal supplementations.This trial was registered at ISRCTN Registry as ISRCTN96502494.

Linear growth determinants of under two years old children in Surabaya, Indonesia

BackgroundChildren under 2 years are in a crucial stage of child development, but they are also vulnerable to nutritional problems, one of which is linear growth faltering. Sociodemographic and health characteristics can influence the linear growth process. This study aimed to analyze the determinants of the linear growth of children under 2 years in four Community Health Centers in Surabaya, Indonesia. MethodA cross-sectional study of 160 parents with children under 2 years was done through consecutive sampling. Sociodemographic and health characteristics were assessed by questionnaires, anthropometric measurements, and secondary data from Maternal and Child Health Book (MCH). The linear growth of the children was identified using length-for-age z-score (LAZ). The data were analyzed using correlation test, One-way ANOVA, independent t-test, and multiple linear regression to see the influential factors. ResultsThe average LAZ for children under 2 years in four Surabaya City Health Centers areas was normal (−0.76 ± 1.70). Maternal height (p:0.001) and birth length (p:0.001) were significantly related to linear growth. The determinants of linear growth were birth length, maternal height, and history of exclusive breastfeeding, with the most considerable beta value of 0.231 on maternal height. ConclusionA maternal height primarily determines children under 2 years of linear growth. Parents with growth hormone deficiency were at risk of inheriting this gene to their children. Community Health Centers as health services can be more active in education and nutritional counseling for teenagers and prospective brides.

Factors associated with stunting in under-five children with environmental enteropathy in slum areas of Jimma town, Ethiopia.

Stunting is a major public health issue with a significant influence on the health and development of children in low-income countries, where it affects up to 32% of children. Nutritional intake is impacted by alterations in intestinal permeability and underlying chronic inflammation, which hinder children's normal linear growth. Environmental enteropathy is a poorly understood condition with chronic intestinal inflammation. The purpose of this study was to identify the magnitude of stunting, change in growth, and factors associated with stunting and change in height for the age Z-score of children with an elevated lactulose-to-mannitol ratio. An observational follow-up study was conducted to follow children with an elevated lactulose-to-mannitol ratio for changes in their linear growth. A lactulose-mannitol test was performed to identify children with elevated lactulose-to-mannitol ratios, indicative of environmental enteropathy. After a 1-year follow-up, anthropometry was repeated to assess their linear growth. A multivariable logistic regression analysis was performed to identify the independent predictors for stunting in children with elevated lactulose-to-mannitol ratios. All tests were two-sided, and a p-value of <0.05 was considered significant. The prevalence of stunting in children with an elevated L:M at baseline and end line was found to be 72.4% (95% CI: 60.3, 84.5) and 78.4% (95% CI: 66.7, 90.2), respectively. In a multivariate analysis, a low dietary diversity score (<4 food groups), presence of flies and insects in the toilet area, poor handwashing practices during a critical time, and MUAC z < -2 were significantly associated with stunting. Flies and insects in the toilet area and unsafe disposal of feces were significantly associated with changes in HAZ in children with elevated lactulose-to-mannitol ratios, an indicator of environmental enteropathy. Most of the children with an elevated lactulose-to-mannitol ratio in the study population were stunted, and no significant change in their linear growth was observed after 1-year follow-up. Therefore, further investigation and urgent intervention are needed to prevent environmental enteropathy and stunting among under-five children in this community who are exposed to very poor sanitary conditions and other risk factors for malnutrition.

Does household’s food and nutrient acquisition capacity predict linear growth in children? Analysis of longitudinal data from rural and small towns in Ethiopia

Nutritious foods are unaffordable to the majority of households in lower-income countries. Hence, starchy staples tend to be the main source of diets for men, women, and children, implying poor diet quality and deficiency in key nutrients that are crucial for child’s physical growth and cognitive development. Much of existing studies on child linear growth or stunting examined the impact of current dietary consumption on physical growth even though the effect of diets and nutrition would only be observed with time lag. This study examined the associations between sustained consumption of animal sourced foods (ASFs) and adequate nutrient intakes (measured by the mean nutrient adequacy (MPA)) and linear growth differences among children in rural and small towns in Ethiopia. Using nationally representative longitudinal data, results of fixed effects estimations suggested that a standard deviation increase in the household MPA was associated with a 10–11% increase in the height-for-age z-score; and a 10% increase in the household MPA was associated with a 3.2 – 5.6% reduction in stunting rate in children 6–59 months of age. Results also indicated some associations between past ASFs consumption and current linear growth outcomes in younger children. The gap in the household MPA was over 41%, indicating the need for nutrient-dense ASFs in the household diets despite the sustainability concerns around ASFs. Key implication is that policies and interventions aimed at improving linear growth outcomes of children in rural and small towns in Ethiopia should improve household’s access to ASFs and nutrient acquisition capacity.

The relationships between optimal infant feeding practices and child development and attained height at age 2 years and 6-7 years.

Limited evidence exists on the long-term effects of early feeding practices on child growth and development. We examined the relationships between infant feeding practices and child height and development at ages 2 and 6-7 years. We studied 885 mother-child dyads from a randomized controlled trial of preconception supplementation in Vietnam. Early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), breastfeeding (BF) duration and minimum dietary diversity (MDD) were assessed using World Health Organization(WHO) guidelines. Child development was assessed by the Bayley Scales of Infant Development-III at 2 years and the Wechsler Intelligence Scale for Children®-IV at 6-7years. Child height-for-age z-score (HAZ) was calculated from child height and age. Multivariable regression and structural equation models were used in analyses that controlled for confounding. EIBF and EBF at 6monthsoccurred in 52% and 62% of children, respectively. Mean breastfeeding duration was 18 monthsand 83% achieved MDD at 1year. EIBF was associated with motor (β = 0.13, 95% confidence interval [CI]: 0.00, 0.28) and cognitive development at 2years(β = 0.12, 95%CI: -0.01, 0.26), which in turn were positively associated with cognitive development at 6-7years. EBF was directly associated with development at 6-7years (β = 0.21, 95% CI:0.08, 0.34) whereas motor and cognitive development at 2years explained 41%-75% of the relationship between EIBF and development at 6-7years. HAZ at 2years also mediated 70% of the association between MDD at 1year and HAZ at 6-7years. BF duration was not associated with child development and HAZ. Early infant feeding practices, especially EIBF and EBF, have important long-term implications for optimizing child linear growth and cognition as they begin school.

Impact of indoor Air Pollution on the Linear growth of children in Jimma, Ethiopia

BackgroundStunting in children is the term for reduced linear growth and development, which is frequently brought on by a persistently inadequate diet, recurrent infections and chronic diseases or poor health conditions. Apart from the classic covariates of stunting, which include diet and illness, the relative contribution of household air pollution to chronic nutrition conditions is least studied. Hence, this study is conducted to investigate the impact of household air pollution on the linear growth of under-five children in Jimma town, Ethiopia.MethodsA prospective cohort study was employed to collect data from 280 under-five children who lived in households using solid fuel (exposed group, n = 140) and clean fuel (unexposed group, n = 140). Height-for-age Z scores were compared in both groups over a 12-month follow-up period. The difference in differences estimators were used for comparison of changes in the height-for-age Z scores from baseline to end line in exposed and non-exposed groups. The independent effect of the use of solid fuels on height-for-age Z scores was analyzed through a multivariable linear regression model. Statistical Significances were declared at P < 0.05 and 95% CI level.ResultsIn an unadjusted model (Model 1), compared with the clean fuel type, the mean difference in the height-for-age Z score of children in households using solid fuel was lower by 0.54 (-0.54, 95% CI -0.97, -0.12, P = 0.011). The beta coefficient remained negative after adjusting for age and sex (Model 2 -0.543, 95% CI -1.373, -0.563) and sociodemographic variables (Model 3: -0.543, 95% CI -1.362, -0.575). In the final model (Model 4), which adjusted for wealth quantile, dietary practice, water, sanitation and hygiene status and household food insecurity access scale, the beta coefficient held the same and significant (beta: -0.543, 95% CI -1.357, -0.579, P < 0.001). Higher HAZ scores were observed among female child (β: = 0.48, 95%CI: 0.28, 0.69), Child with father attended higher education (β: = 0.304 95%CI: 0.304, 95% CI 0.19, 0.41) as compared to male gender and those who did not attend a formal education, respectively. In contrast, child living in households with poor hygiene practices had lower HAZ score (β: -0.226, 95% CI: -0.449, -0.003), P < 0.001.ConclusionsExposure to indoor air pollution was inversely related to linear growth. Furthermore, sex, educational status and hygiene were found relevant predictors of linear growth. In such a setting, there is a need to step up efforts to design and implement public education campaigns regarding the health risks associated with exposure to household air pollution. Promoting improvements to kitchen ventilation and the use of improved cooking stoves, which will help to mitigate the detrimental effects of indoor air pollution on child growth impairment and its long-term effects.

Perspective: Connecting the dots between domestic livestock ownership and child linear growth in low- and middle-income countries.

Child stunting due to linear growth faltering remains a pervasive issue in low- and middle-income countries. Two schools of thought have existed pertaining to the role of domestic livestock ownership (DLO) in child linear growth. On one hand, it is argued that DLO leads to greater income and financial security, resulting in better child-raising conditions, including greater animal-source food (ASF) consumption, having protective effects towards child stunting. On the other hand, researchers argue that DLO contributes to faecal contamination and transmission of zoonotic enteric infections from animals to children, thus having destructive effects on child growth. Reviews of this association have revealed ambiguous findings. In this perspective, we argue that measuring the association between exposures to domesticated animals and child stunting is difficult and the ambiguous associations revealed are a result of confounding and differences in the management of DLO. We also argue that the increasingly prominent area of research of environmental enteric dysfunction, a sub-clinical condition of the small intestine thought to be due to frequent faecal pathogen exposure and associated with stunting, will be a useful tool to measure the potential destructive effects of DLO on child growth. We present our argument andidentify challenges and considerations and directions for future research.