Stunting In Early Life Research Articles

Adherence to age-appropriate feeding practices among Filipino children under two: An analysis of the 2018- 2019 Expanded National Nutrition Survey

Introduction: Age-appropriate feeding in the first two years of life is essential to a child’s growth and development, with health implications that persist throughout life. This study examined the adherence to age-appropriate feeding practices among children 0-23.9 months old based on a constructed index, its association with anthropometric growth, and factors affecting adherence. Methods: A total of 9,138 children aged 0-23.9 months with complete information on infant and young child feeding practices (IYCF), anthropometric measurements, maternal information, and household characteristics were included in the study. Data were extracted from a nationwide survey conducted in 2018-2019. Results: Among children aged 0-23.9 months, 20.7% adhered to age-appropriate feeding criteria. More than half (57.7%) of children below six months adhered to age-appropriate exclusive breastfeeding practices, while 1.4% of children aged 6-8.9 months old started complementary feeding. Continued breastfeeding at 12 months of age while receiving complementary feeding was uncommon (11%). Significantly higher z-scores for weight-for-age (-0.6±0.04), height-for-age (-0.8±0.05), and weight-for-height (-0.2±0.05) were noted among children who adhered to age-appropriate feeding practices compared to those who did not. Child’s age and birth weight, as well as mother’s age, education, and working status, were found to significantly influence the likelihood of adhering to age-appropriate feeding index. Conclusion: Filipino infants and young children under two years of age have low adherence to age-appropriate feeding practices, putting them at a higher risk of repeated occurrence of infection that could lead to stunting in early life.

Peningkatan Pengetahuan Tentang Stunting pada Ibu Balita di Kelurahan Pondok Ranggon Cipayung Jakarta Timur Provinsi DKI Jakarta

Stunting in early life, especially in the first 1000 days from conception to the age of two years, impaired growth has adverse functional consequences in children. The current condition of the COVID-19 pandemic requires more and more multi-sectoral collaboration to prevent these consequences. Some of these consequences include poor cognition and educational performance, poor parenting, low adult wages, lost productivity, and accompanied by excessive weight gain later in life, an increased risk of chronic nutrition-related diseases in adult life. Mother's knowledge of toddlers also plays a role in this effort. Therefore, the purpose of this activity is to increase the knowledge of mothers under five about stunting. The activity was carried out in several Posyandu areas which was carried out in September – October 2022. The implementation was in collaboration with Cadres, Pondok Ranggon Village Health Center, Cipayung District Health Center and Pondok Ranggon Village and Cipayung District. The result of this activity is an increase in partner empowerment through increased knowledge (Post Test Results Increase compared to Pre Test) namely those whose knowledge is good from 95% to 98% after counseling and increasing partner skills (Cross-program collaboration, evidenced by the active involvement of community elements (Village government, RW, cadres, youth organizations and religious leaders.) With the increase in knowledge of mothers and children under five, it is hoped that the role of cooperation with cross-sectors will be increased so that the sustainability of the program can be well maintained. Keywords: Knowledge, Mother, Children Under Five, Stunting

Changes in Systemic Regulatory T Cells, Effector T Cells, and Monocyte Populations Associated With Early-Life Stunting.

Stunting and environmental enteric dysfunction (EED) may be responsible for altered gut and systemic immune responses. However, their impact on circulating immune cell populations remains poorly characterized during early life. A detailed flow cytometry analysis of major systemic immune cell populations in 53 stunted and 52 non-stunted (2 to 5 years old) children living in Antananarivo (Madagascar) was performed. Compared to age-matched non-stunted controls, stunted children aged 2-3 years old had a significantly lower relative proportion of classical monocytes. No significant associations were found between stunting and the percentages of effector T helper cell populations (Th1, Th2, Th17, Th1Th17, and cTfh). However, we found that HLA-DR expression (MFI) on all memory CD4+ or CD8+ T cell subsets was significantly lower in stunted children compared to non-stunted controls. Interestingly, in stunted children compared to the same age-matched non-stunted controls, we observed statistically significant age-specific differences in regulatory T cells (Treg) subsets. Indeed, in 2- to 3-year-old stunted children, a significantly higher percentage of memory Treg, whilst a significantly lower percentage of naive Treg, was found. Our results revealed that both innate and adaptive systemic cell percentages, as well as activation status, were impacted in an age-related manner during stunting. Our study provides valuable insights into the understanding of systemic immune system changes in stunted children.

Are early childhood stunting and catch-up growth associated with school age cognition?-Evidence from an Indian birth cohort.

Millions of children worldwide especially in the Asian subcontinent are vulnerable to early childhood stunting. There are contradictory reports of the association between catch-up growth in childhood and school age cognition. A community-based birth cohort recruited between 2010 and 2012 from urban slums in Vellore, India was followed up until 9 years of age. From regular anthropometric measurements, stunting status for each individual child was calculated at 2, 5 and 9 years. Cognition was assessed at 9 years of age using the Malin's Intelligence Scale for Indian Children (MISIC). Children were divided into groups based on stunting at each time point as well as catch-up growth, and a regression model was utilised to evaluate their association with cognition at 9 years. Among 203 children included in this analysis, 94/203 (46.31%) children were stunted at 2 years of age, of whom 39.36% had a catch-up growth at 5 years of age, and 38.30% at 9 years. Around 10% of the cohort remained stunted at all time points. In the multivariable analysis, children who were stunted at 2, 5 and 9 years had a significantly lower verbal and total intelligence quotient (IQ) scores by 4.6 points compared to those who were never stunted. Children with catch up growth following stunting at 2 years had higher cognition scores than those who were persistently stunted throughout the childhood. This study showed persistent stunting in childhood was associated with lowering of 4-5 IQ points in childhood cognition at 9 years of age. Recovery from early life stunting in children with catch up growth prevented further lowering of cognition scores in these children compared to persistently stunted children. Nutritional supplementation during late infancy and early toddlerhood in addition to continuing nutritional supplementation programmes for preschool and school children can improve childhood stunting and cognitive abilities in vulnerable populations.

Changes in Systemic Regulatory T Cells, Effector T Cells and Monocyte Populations Associated with Early Life Stunting

Changes in Systemic Regulatory T Cells, Effector T Cells and Monocyte Populations Associated with Early Life Stunting

Developmental origins of variability in pelvic dimensions: Evidence from nulliparous South Asian women in the United Kingdom.

ObjectivesPelvic growth may be sensitive to early‐life nutrition, with implications for maternal risk of obstructed labor. However, the “developmental origins” of adult pelvic variability require further investigation. We tested whether adult pelvic dimensions are associated with two components of height, indexing different periods of linear growth: tibia length, a proxy for early postnatal growth, and height‐residual (height regressed on tibia length), a proxy for later growth. We also tested whether adult pelvic dimensions are associated with birth weight, a marker of nutritional investment in utero.MethodsIn this cross‐sectional study, data were obtained on 68 nulliparous young women of South Asian ancestry. Pelvic dimensions (bi‐iliac and bi‐acetabular breadth, anteroposterior pelvic inlet and outlet, interspinous and intertuberous diameter) were measured using magnetic resonance imaging. Height and tibia length were measured manually. Birth weight and gestational age were obtained by recall. Multivariable regression models were fitted with a given pelvic dimension regressed on height‐residual, tibia, and birth weight, with the latter adjusted for gestational age.ResultsControlling for birth weight, height‐residual was predictive of bi‐acetabular breadth, bi‐iliac breadth, and the pelvic inlet, while tibia length significantly predicted all dimensions except interspinous diameter. Controlling for the linear growth variables, birth weight was predictive of bi‐iliac breadth only.ConclusionsMarkers of linear growth during both early and later development were associated with adult pelvic dimensions, whereas size at birth was poorly predictive. Efforts to reduce stunting in early life may facilitate the attainment of maximum potential growth for both height and the pelvis.

Associations of stunting in early childhood with cardiometabolic risk factors in adulthood

Early life stunting may have long-term effects on body composition, resulting in obesity-related comorbidities. We tested the hypothesis that individuals stunted in early childhood may be at higher cardiometabolic risk later in adulthood. 1753 men and 1781 women participating in the 1982 Pelotas (Brazil) birth cohort study had measurements of anthropometry, body composition, lipids, glucose, blood pressure, and other cardiometabolic traits at age 30 years. Early stunting was defined as height-for-age Z-score at age 2 years below -2 against the World Health Organization growth standards. Linear regression models were performed controlling for sex, maternal race/ethnicity, family income at birth, and birthweight. Analyses were stratified by sex when p-interaction<0.05. Stunted individuals were shorter (β = -0.71 s.d.; 95% CI: -0.78 to -0.64), had lower BMI (β = -0.14 s.d.; 95%CI: -0.25 to -0.03), fat mass (β = -0.28 s.d.; 95%CI: -0.38 to -0.17), SAFT (β = -0.16 s.d.; 95%CI: -0.26 to -0.06), systolic (β = -0.12 s.d.; 95%CI: -0.21 to -0.02) and diastolic blood pressure (β = -0.11 s.d.; 95%CI: -0.22 to -0.01), and higher VFT/SAFT ratio (β = 0.15 s.d.; 95%CI: 0.06 to 0.24), in comparison with non-stunted individuals. In addition, early stunting was associated with lower fat free mass in both men (β = -0.39 s.d.; 95%CI: -0.47 to -0.31) and women (β = -0.37 s.d.; 95%CI: -0.46 to -0.29) after adjustment for potential confounders. Our results suggest that early stunting has implications on attained height, body composition and blood pressure. The apparent tendency of stunted individuals to accumulate less fat-free mass and subcutaneous fat might predispose them towards increased metabolic risks in later life.

Are stunted young Indonesian children more likely to be overweight, thin, or have high blood pressure in adolescence?

To determine whether stunted young children are at greater risk of (1) overweight/obesity or thinness, and (2) high blood pressure (HBP) in adolescence. A secondary data analysis using the Indonesian Family Life Survey waves 1 (1993) to 4 (2007). We generated a 14-year follow-up cohort (1993-2007) and two 7-year cohorts (1993-2000 and 2000-2007) of children aged 2.0-4.9years. Stunting (HAZ<-2), thinness (BMIZ<-2), and overweight/obesity (BMIZ>+1) were determined based upon the WHO Child Growth Standards. HBP (>90th percentile) was interpreted using the 4th Report on the Diagnosis of HBP in Children and Adolescents. 765, 1083, and 1589 children were included in the 14-year cohort, and the two 7-year cohort analyses, respectively. In the 7-year cohorts, early life stunting was inversely associated with overweight/obesity (prevalence ratio 0.32 and 0.38, respectively; P<0.05), but no significant association was found with the 14-year cohort. There was no significant association between childhood stunting and thinness at adolescence or in the odds/likelihood of having high systolic or diastolic blood pressure. We found no association between early life stunting and overweight/obesity, thinness and HBP in adolescence.

Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction.

BackgroundStunting in early life has considerable human and economic costs. The purpose of the study was to identify factors associated with stunting among children aged 0-23 months in Indonesia to inform the design of appropriate policy and programme responses.MethodsDeterminants of child stunting, including severe stunting, were examined in three districts in Indonesia using data from a cross-sectional survey conducted in 2011. A total of 1366 children were included. The analysis used multiple logistic regression to determine unadjusted and adjusted odds ratios.ResultsThe prevalence of stunting and severe stunting was 28.4 % and 6.7 %, respectively. The multivariate analysis on determinants of stunting identified a significant interaction between household sanitary facility and household water treatment (P for interaction = 0.007) after controlling for potential covariates: in households that drank untreated water, the adjusted odds on child stunting was over three times higher if the household used a unimproved latrine (adjusted odds ratio 3.47, 95 % confidence interval 1.73-7.28, P <0.001); however, in households that drank treated water, the adjusted odds on child stunting was not significantly higher if the household used an unimproved latrine (adjusted odds ratio 1.27, 95 % confidence interval 0.99-1.63, P = 0.06). Other significant risk factors included male sex, older child age and lower wealth quintile. The risk factors for severe stunting included male sex, older child age, lower wealth quintile, no antenatal care in a health facility, and mother’s participation in decisions on what food was cooked in the household.ConclusionsThe combination of unimproved latrines and untreated drinking water was associated with an increased odds on stunting in Indonesia compared with improved conditions. Policies and programmes to address child stunting in Indonesia must consider water, sanitation and hygiene interventions. Operational research is needed to determine how best to converge and integrate water, sanitation and hygiene interventions into a broader multisectoral approach to reduce stunting in Indonesia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3339-8) contains supplementary material, which is available to authorized users.

Does pre-school improve cognitive abilities among children with early-life stunting? A longitudinal study for Peru

Several studies in developing countries have found that children who experience growth faltering in the first years of life show lower cognitive abilities than their peers. In this study, we use the Young Lives longitudinal dataset in Peru to analyze if attending pre-school affects cognitive abilities at age five years, and if there is an interaction with HAZ at age one year. Using instrumental variables we found, for receptive vocabulary, a positive effect of attending Jardines (formal) pre-schools; the effect of attending PRONOEI (community-based) pre-schools was not significant. More years attending Jardines was more beneficial for children who were better nourished. We suggest working to improve the quality of PRONOEIs, and with teachers on targeting children of lower nutritional status.

Mesalazine in the initial management of severely acutely malnourished children with environmental enteric dysfunction: a pilot randomized controlled trial.

BackgroundEnvironmental enteric dysfunction (EED) is an acquired syndrome of impaired gastrointestinal mucosal barrier function that is thought to play a key role in the pathogenesis of stunting in early life. It has been conceptualized as an adaptive response to excess environmental pathogen exposure. However, it is clinically similar to other inflammatory enteropathies, which result from both host and environmental triggers, and for which immunomodulation is a cornerstone of therapy.MethodsIn this pilot double-blind randomized placebo-controlled trial, 44 children with severe acute malnutrition and evidence of EED were assigned to treatment with mesalazine or placebo for 28 days during nutritional rehabilitation. Primary outcomes were safety and acceptability of the intervention.ResultsTreatment with mesalazine was safe: there was no excess of adverse events, evidence of deterioration in intestinal barrier integrity or impact on nutritional recovery. There were modest reductions in several inflammatory markers with mesalazine compared to placebo. Depression of the growth hormone – insulin-like growth factor-1 axis was evident at enrollment and associated with inflammatory activation. Increases in the former and decreases in the latter correlated with linear growth.ConclusionsIntestinal inflammation in EED is non-essential for mucosal homeostasis and is at least partly maladaptive. Further trials of gut-specific immunomodulatory therapies targeting host inflammatory activation in order to optimize the growth benefits of nutritional rehabilitation and to address stunting are warranted. Funded by The Wellcome Trust.Trial registrationRegistered at Clinicaltrials.gov NCT01841099.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0133-2) contains supplementary material, which is available to authorized users.

Long‐term consequences of stunting in early life

This review summarizes the impact of stunting, highlights recent research findings, discusses policy and programme implications and identifies research priorities. There is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life. Recent research findings, including follow-up of an intervention trial in Guatemala, indicate that stunting can have long-term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes. This evidence has contributed to the growing scientific consensus that tackling childhood stunting is a high priority for reducing the global burden of disease and for fostering economic development. Follow-up of randomized intervention trials is needed in other regions to add to the findings of the Guatemala trial. Further research is also needed to: understand the pathways by which prevention of stunting can have long-term effects; identify the pathways through which the non-genetic transmission of nutritional effects is mediated in future generations; and determine the impact of interventions focused on linear growth in early life on chronic disease risk in adulthood.

Síndrome metabólica e baixa estatura em adultos da região metropolitana de São Paulo (SP, Brasil)

The undernutrition has been appointed as a risk factor to cause chronic diseases in later life. The objective of this study was to investigate the prevalence of metabolic syndrome and its relationship to short stature, as evidence of stunting in early life in adults. It is a cross-sectional study of adult population (age 20 to 64 years old) living in the metropolitan area of São Paulo city (SP, Brazil). The sample comprehended a total of 287 individuals, 214 (74.6%) were women and 73 (25.4%) were men. The anthropometric, clinical and biochemical data were collected through the physical exam and the fast blood after 8 hours. The standard prevalence for sex and age to metabolic syndrome was 34.0% and the short stature was 29.0%. In multiple logistic regression analyses the metabolic syndrome showed to be associated to short stature adjusted by sex, age, education, income, smoking, alcohol consumption, family history of coronary disease, hypertension, diabetes and body mass index. In this study was demonstrated association between metabolic syndrome and short stature in adults.

Long-term consequences of early linear growth retardation (stunting) in Swedish children.

Linear growth retardation (stunting) is prevalent (10-80%) in developing countries. It takes place between 6 and 18 mo of age and can be characterized by the delayed onset of the childhood phase of growth. The objective of this work was to study the existence of stunting in early life and, when present, its lifelong effects on final height in a normal healthy population in a developed country. A total of 2432 children with longitudinal height data from birth to adulthood were analyzed. The series represents a normal healthy population-based sample of full-term children born around 1974 in Göteborg, Sweden. We found the incidence of stunting to be about 10% as indicated by delayed onset of the childhood phase of growth (>12 mo of age): 14% in boys and 8% in girls. In a multiple linear regression model, final height was described by length at 6 mo of age, age at onset of the childhood phase of growth, and age at peak height velocity during puberty. All three measures contributed significantly (p < 0.05) to final height with a total R2 of 0.33. A final height difference of 5.0 cm could be explained by abnormal onset of the childhood phase of growth in this normal population. The timing of the childhood onset of growth did not correlate with the timing of puberty. For the first time, we can conclude that stunting in early life is not only a problem in developing countries. Its importance on final height achieved is clearly shown, even after controlling for the timing of puberty.

Risk factors for impaired length growth in early life viewed in terms of the infancy‐childhood‐puberty (ICP) growth model

A difference in length or height growth is observed between populations in developing and developed countries and, within a country, between well‐off and poor subpopulations. The aim of this community‐based study was to identify possible risk factors for growth stunting in early life using the infancy‐childhood‐puberty (ICP) growth model. A periurban slum, a village and an urban slum, plus a local control group in Lahore, Pakistan, were investigated. In total, there were 425 infants born from September 1984 to March 1987 in the study. Children were followed from birth to 24 months and anthropometric data were recorded at each examination. A well‐designed questionnaire was used to collect background information to identify risk factors for growth faltering over this period. The age at onset of the childhood component was determined individually using the ICP growth model. A late onset was defined as onset after 12 months. Univariate odds ratio analysis identified 20 significant risk factors for a delayed childhood onset in the total sample. Backward logistical analysis showed that only six variables were significant, i.e. small number of rooms in a household, episode(s) of diarrhoeal diseases, poor house structure, low body mass index, early end of breastfeeding and birth in warm season. Stratified analysis showed that episode(s) of diarrhoeal diseases and birth in warm season were the only significant risk factors in the two poor areas. This study also found that the impact of diarrhoeal diseases on length growth persisted after allowing for birth season. Seasonal variation in length growth was seen in the age at onset of the childhood component. General socioeconomic status was found to be a risk factor for growth faltering in early life. Diarrhoeal diseases and being born in a warm season are particular risk factors for growth faltering in early life.

Growth stunting in early life in relation to the onset of the childhood component of growth.

Growth stunting is prevalent in developing countries. The prevalence of stunting ranges from 10-80% or more. The critical period for growth faltering in length is between six and 18 months. The aims of this study were 1) to investigate the association between the age at onset of the childhood component and growth stunting in early life; 2) to develop a screening method for identifying any individual infant subject to stunting in early life. This community-based longitudinal study was carried out in Lahore, Pakistan. Three studied areas and one local control group were included in the study. There were 425 subjects for whom data were available for determining the age at onset of the childhood component. The onset was defined as an abrupt increase in length velocity. It was determined individually using the infancy-childhood-puberty growth model. The medians of the age at onset of childhood component were 15, 13, 10 and 9 months in the periurban, village, urban and control groups, respectively. The onset was significantly related to both length and length velocity during the critical period of stunting. Based on the distribution of individual length increment from 12 to 15 months, 2.0 and 3.0 cm were chosen as the cut-off points to identify a stunting infant. In the normal onset group, 84% of the children were identified as growing normally; in the delayed onset group, 61% were identified as stunting. Using this screening method, 97% of children have a delayed onset if their length increase is below 2 cm from 12 to 15 months; 99% of them have a normal onset if the increase is above 3 cm over the same period. The age at onset of the childhood component can significantly explain the variations in both length and length velocity in early life. The stunting screening method reported here is simple. It can be used in almost any situation, such as a pediatric clinic or community-based survey.