A socioeconomic lens on understanding early childhood linear growth faltering

Environmental enteric dysfunction (EED) is a subclinical condition of intestinal inflammation, barrier dysfunction and malabsorption associated with growth faltering in children living in poverty. This study explores association of altered duodenal permeability (lactulose, rhamnose and their ratio) with higher burden of enteropathogen in the duodenal aspirate, altered histopathological findings and higher morbidity (diarrhea) that is collectively associated with linear growth faltering in children living in EED endemic setting. In a longitudinal birth cohort, 51 controls (WHZ > 0, HAZ > −1.0) and 63 cases (WHZ< -2.0, refractory to nutritional intervention) were recruited. Anthropometry and morbidity were recorded on monthly bases up to 24 months of age. Dual sugar assay of urine collected after oral administration of lactulose and rhamnose was assessed in 96 children from both the groups. Duodenal histopathology (n = 63) and enteropathogen analysis of aspirate via Taqman array card (n = 60) was assessed in only cases. Giardia was the most frequent pathogen and was associated with raised L:R ratio (p = 0.068). Gastric microscopy was more sensitive than duodenal aspirate in H. pylori detection. Microscopically confirmed H. pylori negatively correlated with HAZ at 24 months (r = −0.313, p = 0.013). Regarding histopathological parameters, goblet cell reduction significantly correlated with decline in dual sugar excretion (p< 0.05). Between cases and controls, there were no significant differences in the median (25th, 75th percentile) of urinary concentrations (μg/ml) of lactulose [27.0 (11.50, 59.50) for cases vs. 38.0 (12.0, 61.0) for controls], rhamnose [66.0 (28.0, 178.0) vs. 86.5 (29.5, 190.5)] and L:R ratio [0.47 (0.24, 0.90) vs. 0.51 (0.31, 0.71)] respectively. In multivariable regression model, 31% of variability in HAZ at 24 months of age among cases and controls was explained by final model including dual sugars. In conclusion, enteropathogen burden is associated with altered histopathological features and intestinal permeability. In cases and controls living in settings of endemic enteropathy, intestinal permeability test may predict linear growth. However, for adoption as a screening tool for EED, further validation is required due to its complex intestinal pathophysiology.

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Linear growth faltering and the role of weight attainment: Prospective analysis of young children recovering from severe wasting in Niger

Maternal and Child Nutrition ◽

10.1111/mcn.12817 ◽

2019 ◽

Vol 15 (4) ◽

Cited By ~ 3

Author(s):

Sheila Isanaka ◽

Matt D.T. Hitchings ◽

Fatou Berthé ◽

André Briend ◽

Rebecca F. Grais

Keyword(s):

Young Children ◽

Linear Growth ◽

Prospective Analysis ◽

Growth Faltering

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Linear Growth Faltering Among HIV-Exposed Uninfected Children

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000001034 ◽

2016 ◽

Vol 73 (2) ◽

pp. 182-189 ◽

Cited By ~ 15

Author(s):

Christopher R. Sudfeld ◽

Quanhong Lei ◽

Yvonne Chinyanga ◽

Esther Tumbare ◽

Nealia Khan ◽

...

Keyword(s):

Linear Growth ◽

Growth Faltering ◽

Hiv Exposed ◽

Exposed Uninfected

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Patterns of growth in childhood in relation to adult schooling attainment and IQ in 6 birth cohorts in low and middle-income countries: evidence from COHORTS

10.1101/2020.06.16.20133074 ◽

2020 ◽

Author(s):

Natalia E Poveda ◽

Fernando P Hartwig ◽

Cesar G Victora ◽

Linda S Adair ◽

Fernando C Barros ◽

...

Keyword(s):

Human Capital ◽

Early Childhood ◽

Early Life ◽

Linear Growth ◽

Relative Weight ◽

Childhood And Adolescence ◽

Birth Cohorts ◽

Middle Income ◽

Middle Income Countries ◽

School Attainment

SummaryBackgroundGrowth faltering has been associated with poor intellectual performance. The relative strengths of associations between growth in early and in later childhood remain underexplored. We examined the association between growth in childhood and adolescence and adult human capital in five low- or middle-income countries (LMICs).MethodsWe analyzed data from six prospective birth cohorts of five LMICs (Brazil, Guatemala, India, the Philippines, and South Africa). We assessed the associations of measures of height and relative weight at four ages (birth, at around age 2 years, mid-childhood (MC), adulthood), with two dimension of adult human capital (schooling attainment and IQ).FindingsIn site- and sex-pooled analyses, size at birth and linear growth from birth to around 2 years of age were positively associated with schooling attainment and adult IQ. Linear growth from age 2 years to MC and from MC to adulthood was not associated with higher school attainment or IQ. Change in relative weight in early childhood was not associated with either outcome. Relative weight in MC and in adulthood were inversely associated with schooling attainment but were not associated with adult IQ.InterpretationLinear growth in the first 1,000 days is a predictor of schooling attainment and IQ in adulthood in LMICs. Linear growth in later periods was not associated with either of these outcomes. Changes in relative weight had inconsistent association with schooling and IQ in adulthood.FundingBill and Melinda Gates Foundation (OPP1164115)Research in contextEvidence before this studyEarly life growth faltering has been associated with poor cognitive and intellectual performance in childhood and poorer schooling outcomes in children and adults. There is a paucity of data about how growth in specific age intervals over the course of childhood and adolescence relates to attained schooling and adult cognitive performance.We conducted a literature search using the terms (growth [Title/Abstract]) AND ((school [Title/Abstract] OR schooling [Title/Abstract]) AND (intelligence [Title/Abstract] OR IQ [Title/Abstract]) OR (human capital [Title/Abstract]) in Pubmed. The search yielded 536 publications from 1965 to 2020. We screened titles and selected 31 publications that included linear growth and our outcomes of interest, namely school attainment and intelligence quotient (IQ). Additionally, we checked reference lists of selected articles and identified eleven papers that were not displayed in the initial electronic query. We therefore reviewed 42 abstracts and identified 24 unique studies conducted in low and middle-income countries (LMICs). Fourteen of them investigated the association of birth size and/or early-life size with schooling or IQ, or with both outcomes during childhood. Three studies investigated the association between linear growth in early childhood and schooling and intelligence in adults, one studied the association between early-life undernutrition and IQ in early adulthood and another six publications investigated the association between growth and school attainment in adults. Economists have also studied the relationship between stunting or linear growth and schooling in LMICs, but to our knowledge not the relative importance of growth during specific age intervals.Added value of this studyThis is an analysis of the associations between child and adolescent growth and two dimensions of human capital (schooling attainment and IQ) in adulthood in six birth cohorts from five LMICs. The evidence of long-term associations of linear growth with adult IQ is scarce and the few published studies have analyzed data from a single country. In the present study, we found that size at birth and linear growth from birth to around 2 years of age were positively associated with both schooling and IQ in adulthood. Linear growth between early and mid-childhood (MC)was not associated with higher school attainment or IQ in adjusted models. Linear growth from MC to adulthood was not associated with IQ in men or women, and was inversely associated with schooling attainment in women only. Change in relative weight in early childhood was positively associated with schooling attainment only in minimally adjusted models. Relative weight measures in MC and adulthood were inversely associated with schooling attainment. Change in relative weight between MC and adulthood was not associated with adult IQ.Implications of all the available evidenceWe confirmed in multiple cohorts that birth size and linear growth from birth to age 2 years are predictors of schooling attainment and adult IQ. Linear growth in early life was the strongest predictor of these two human capital dimensions in adulthood among individuals in LMICs. We did not find evidence that supports the notion that linear growth in adolescence contributes to a better cognitive performance in adulthood. Thus, our results inform the more effective timing of nutritional and other interventions to improve linear growth and human capital in the long-term.

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Vitamin D Status in Early Childhood and Neurodevelopment and Growth at Age 6–9 Years in North India (P11-061-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-061-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Ranadip Chowdhury ◽

Sunita Taneja ◽

Ingrid Kvestad ◽

Mari Hysing ◽

Nita Bhandari ◽

...

Keyword(s):

Vitamin D ◽

Early Childhood ◽

Vitamin D Deficiency ◽

Middle Childhood ◽

Linear Growth ◽

Controlled Trial ◽

North India ◽

Vitamin D Status ◽

Indian Children

Abstract Objectives The extent to which vitamin-D deficiency (< 10 ng/ml) is associated with neurodevelopment and linear growth in middle childhood. Methods The study is a follow-up of a factorial randomized double-blind placebo-controlled trial in 1000 North Indian children 6 to 30 months at enrolment, receiving daily 2 RDAs of vitamin B12 and/or folic acid or placebo for 6 months. When the children were 6–9 years old, we included 791 for cognitive assessments with the Wechsler Intelligence Scale for Children, 4th edition INDIA (WISC-IV), Crichton Verbal Scale (CVS), NEPSY-II and BRIEF 2 and linear growth. Multiple logistic and linear regressions were used to examine the association between vitamin-D deficiency at baseline and neurodevelopment and growth in middle childhood. Results Among the 791 children who consented to participate, baseline Vitamin D status was available for 716 children who were included in this analysis. Of these, 251 (35.1%) were vitamin-D deficient (< 10 ng/ml). There were no significant differences in any of the cognitive outcomes between vitamin-D deficient and non-deficient children. Also, we did not find any association between linear growth at follow up and vitamin D deficiency at baseline. Conclusions The results from this analysis do not support that vitamin-D deficiency in early childhood is important for growth and neurodevelopment in middle childhood. Funding Sources Thrasher Research Fund; The Research Council of Norway. Supporting Tables, Images and/or Graphs

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Identifying Faltering of Growth Velocity and Associated Risk Factors Among Preschool Aged Children in Nepal

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_069 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 864-864

Author(s):

Swetha Manohar ◽

Andrew Thorne-Lyman ◽

Elizabeth Colantuoni ◽

K C Angela ◽

Binod Shrestha ◽

...

Keyword(s):

Risk Factors ◽

Growth Velocity ◽

Regression Models ◽

Linear Growth ◽

Height Velocity ◽

Individual Risk ◽

Z Score ◽

Poor Growth ◽

Growth Faltering ◽

Increased Risk

Abstract Objectives Linear growth failure is often assessed as a height-for-age z-score (HAZ) < −2, which defines stunting. Faltering growth velocity on the other hand reveals a dynamic process, for which improving risk factors could help prevent poor growth, regardless of HAZ. Our aim was to reveal rates and risk factors of growth faltering in Nepali preschool children using a novel linear growth velocity (LGV) reference. Methods We assessed length/height in children under-five from 2013–16 during the same season in 21 wards across the plains (Tarai) of Nepal (n = 4439). Annualized LGVs were calculated from paired measures and stratified into interval-initiating ages of <6, 6–11, 12–23, 24–35, 36–47, 48–59 mo. An annualized, age-sex-specific LGV reference was derived by combining the WHO Growth Standards (for intervals starting <12 mo) and the Tanner Height Velocity Reference (for intervals starting later) using linear restricted cubic spline regression models, from which LGV z-scores (LGVZ) were derived and used to evaluate Nepali child growth. Community, household and individual risk factors were assessed during interval-initiating visits and subjected to multivariable logistic regression models to examine associations with LGVZ < −2 (growth faltering) vs > 2. Results LGV faltering affected 29.8% and 34.8% of boys and girls <24 months, and 6.8% and 7.1% 24–60 months, respectively. Girls were at higher odds of faltering, although 95% CI excluded 1 only for the interval starting at 12–23 mo (OR: 1.77; 95% CI: 1.26, 2.50). Children <24 mo whose weight-for-height z- score was > the WHO median had lower odds of faltering than thinner children (OR: 0.25 - 0.40, all upper 95% CLs < 1). Children of short (<150 cm) mothers had higher odds of faltering, with 95% CIs excluding 1 for interval-initiating ages < 6, 12–23 and 24–35 mo. Above 36 mo, community characteristics such as proximity to market, and access to roads and schools were stronger in their protective growth association than individual or household factors. Conclusions Growth faltering can be assessed across all preschool years by this WHO-Tanner linear growth velocity reference. Nepali children exhibited substantial growth faltering <24 months. Females, children who were thin, and born to short mothers were at an increased risk of growth faltering. Funding Sources USAID, Sight and Life, and Procter & Gamble.

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