Influences on catch-up growth using relative versus absolute metrics: evidence from the MAL-ED cohort study

Abstract Background Poor growth in early childhood has been considered irreversible after 2–3 years of age and has been associated with morbidity and mortality over the short-term and with poor economic and cognitive outcomes over the long-term. The MAL-ED cohort study was performed in eight low-income settings with the goal of evaluating relationships between the child’s environment and experience (dietary, illness, and pathogen exposure, among others) and their growth and development. The goal of this analysis is to determine whether there are differences in the factors associated with growth from 24 to 60 months using two different metrics. Methods Across six MAL-ED sites, 942 children had anthropometry data at 24 and 60 months, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9 to 24 months, and micronutrient status. Anthropometric changes were in height- or weight-for-age z-score (HAZ, WAZ), their absolute difference from the growth standard median (HAD (cm), WAD (kg)), as well as recovery from stunting/underweight. Outcomes were modeled using multivariate regression. Results At 24 months, almost half of the cohort was stunted (45%) and 21% were underweight. Among those who were stunted at 24 months (n = 426), 185 (43%) were no longer stunted at 60 months. Most children increased their HAZ from 24 to 60 months (81%), whereas fewer (33%) had positive changes in their HAD. Linear regression models indicate that girls improved less than boys from 24 to 60 months (HAZ: -0.21 (95% CI -0.27, -0.15); HAD: -0.75 (-1.07, -0.43)). Greater intestinal permeability (higher LMZ) at 0–24 months was associated with lower relative and absolute changes from 24 to 60 months (HAZ: -0.10 (-0.16, -0.04); HAD: -0.47 (-0.73, -0.21)). Maternal height (per 10 cm) was positively associated with changes (HAZ: 0.09 (0.03, 0.15); HAD: 0.45 (0.15, 0.75)). Similar relationships were identified for changes in WAZ and WAD. Conclusions The study children demonstrated improved growth from 24 to 60 months of age, but only a subset had positive changes in HAD and WAD. The same environmental factors were associated with growth from 24 to 60 months regardless of metric used (change in HAZ or HAD, or WAZ and WAD).

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Influences on catch-up growth using relative versus absolute metrics: Evidence from the MAL-ED cohort study

10.21203/rs.3.rs-28471/v1 ◽

2020 ◽

Author(s):

Stephanie A Richard ◽

Benjamin JJ McCormick ◽

Laura E Murray-Kolb ◽

Pascal Bessong ◽

Sanjaya K Shrestha ◽

...

Keyword(s):

Linear Regression ◽

Cognitive Outcomes ◽

Absolute Difference ◽

Maternal Height ◽

Z Score ◽

Linear Regression Models ◽

Negatively Associated ◽

Growth Standards ◽

Catch Up ◽

Protein Density

Abstract Background: Undernutrition in early childhood has historically been considered irreversible after 2-3 years of age and has been associated with morbidity and mortality over the short-term and poor economic and cognitive outcomes over the long-term. We used longitudinal data to determine which factors are associated with positive changes in absolute and relative differences in height and weight from the WHO Growth Standards from 24 to 60 months of age.Methods: Across six MAL-ED sites, 942 children had anthropometry data at 24 and 60 months, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9-24 months, and micronutrient status. Anthropometric changes were categorized as positive changes in height- or weight-for-age z-score (HAZ, WAZ) or their absolute difference from the growth standard median (HAD (cm), WAD (kg)), as well as recovery from stunting/underweight. Outcomes were modeled using multivariate linear regression.Results: Forty-three/34% of the children who were stunted/underweight at 24 months were no longer stunted/underweight at 60 months, Among the sites, 64-92% of children had positive changes in their HAZ, whereas 25-60% had positive changes in HAD. Linear regression models indicate that female sex (-0.21 HAZ (95% CI -0.27, -0.15); -0.75 HAD (-1.07, -0.43)) and mean LMZ (0-24 months) (-0.10 HAZ (-0.16, -0.04); -0.47 HAD (-0.73, -0.21)) were negatively associated with change in both metrics, and maternal height was positively associated with both (0.09 HAZ (0.03, 0.15); 0.45 HAD (0.15, 0.75)). Similar relationships were identified for change in WAZ and WAD. Dietary protein density was negatively associated with change in WAZ and WAD (-0.05 WAZ (-0.09, -0.01); -0.11 WAD (-0.21, -0.01)), and mean plasma transferrin receptor concentration was positively associated with change in WAZ and WAD (0.02 WAZ (0.0, 0.04); 0.04 WAD (0.0, 0.08)).Conclusions: While children in the MAL-ED study demonstrated recovery from stunting and underweight from 24-60 months of age, they also lost additional centimeters and grams when compared to the WHO median references. Given the similarities in the factors associated with changes in HAZ and HAD (and WAZ and WAD), both can be used to characterize catch-up growth during childhood.Funding Sources: The MAL-ED study was supported by the Bill & Melinda Gates Foundation, with grants to the Foundation for the NIH and NIH/FIC.

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Enteric dysfunction and other factors associated with attained size at 5 years: MAL-ED birth cohort study findings

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz004 ◽

2019 ◽

Vol 110 (1) ◽

pp. 131-138 ◽

Cited By ~ 10

Author(s):

Stephanie A Richard ◽

Benjamin J J McCormick ◽

Laura E Murray-Kolb ◽

Gwyneth O Lee ◽

Jessica C Seidman ◽

...

Keyword(s):

Cohort Study ◽

Low Income ◽

Bacterial Density ◽

Birth Cohort Study ◽

Poor Growth ◽

Mortality And Morbidity ◽

Negatively Associated ◽

Increased Risk ◽

Z Scores

ABSTRACT Background Poor growth in early childhood has been associated with increased risk of mortality and morbidity, as well as long-term deficits in cognitive development and economic productivity. Objectives Data from the MAL-ED cohort study were used to identify factors in the first 2 y of life that are associated with height-for-age, weight-for-age, and body mass index z-scores (HAZ, WAZ, BMIZ) at 5 y of age. Methods A total of 1017 children were followed from near birth until 5 y of age at sites in Bangladesh, Brazil, India, Nepal, Peru, South Africa, and Tanzania. Data were collected on their growth, environmental enteric dysfunction (EED), micronutrient status, enteric pathogen burden, illness prevalence, dietary intake, and various other socio-economic and environmental factors. Results EED biomarkers were related to size at 5 y. Mean lactulose:mannitol z-scores during the first 2 y of life were negatively associated with all of the growth measures (HAZ: −0.11 [95% CI: −0.19, −0.03]; WAZ: −0.16 [95% CI: −0.26, −0.06]; BMIZ: −0.11 [95% CI: −0.23, 0.0]). Myeloperoxidase was negatively associated with weight (WAZ: −0.52 [95% CI: −0.78, −0.26] and BMIZ: −0.56 [95% CI: −0.86, −0.26]); whereas α-1-antitrypsin had a negative association with HAZ (−0.28 [95% CI: −0.52, −0.04]). Transferrin receptor was positively related to HAZ (0.18 [95% CI: 0.06, 0.30]) and WAZ (0.21 [95% CI: 0.07, 0.35]). Hemoglobin was positively related to HAZ (0.06 [95% CI: 0.00, 0.12]), and ferritin was negatively related to HAZ (−0.08 [95% CI: −0.12, −0.04]). Bacterial density in stool was negatively associated with HAZ (−0.04 [95% CI: −0.08, 0.00]), but illness symptoms did not have any effect on size at 5 y. Conclusions EED markers, bacterial density, and iron markers are associated with growth at 5 y of age. Interventions to reduce bacterial burden and EED may improve long-term growth in low-income settings.

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Cognitive Outcome in Childhood-Onset Epilepsy: A Five-Decade Prospective Cohort Study

Journal of the International Neuropsychological Society ◽

10.1017/s1355617716001077 ◽

2017 ◽

Vol 23 (4) ◽

pp. 332-340 ◽

Cited By ~ 7

Author(s):

Mira Karrasch ◽

Petri Tiitta ◽

Bruce Hermann ◽

Juho Joutsa ◽

Shlomo Shinnar ◽

...

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Population Based ◽

Cognitive Outcomes ◽

Cognitive Outcome ◽

Healthy Controls ◽

Childhood Onset ◽

Semantic Function ◽

Active Epilepsy

AbstractObjectives: Little is known about the very long-term cognitive outcome in patients with childhood-onset epilepsy. The aim of this unique prospective population-based cohort study was to examine cognitive outcomes in aging participants with childhood-onset epilepsy (mean onset age=5.3 years) five decades later (mean age at follow-up=56.5 years).Methods: The sample consisted of 48 participants with childhood-onset epilepsy and 48 age-matched healthy controls aged 48–63 years. Thirty-six epilepsy participants were in remission and 12 continued to have seizures. Cognitive function was examined with 11 neuropsychological tests measuring language and semantic function, episodic memory, and learning, visuomotor function, executive function, and working memory. Results: The risk of cognitive impairment was very high in participants with continuing seizures; odds ratio (OR)=11.7 (95% confidence interval [CI] (2.8, 49.6), p=.0008). They exhibited worse performances across measures of language and semantic function, and visuomotor function compared to participants with remitted epilepsy and healthy controls. In the participants with remitted epilepsy, the risk of cognitive impairment was somewhat elevated, but not statistically significant; OR=2.6 (95% CI [0.9, 7.5], p=.08).Conclusions: Our results showed that the distinction of continued versus discontinued seizures was critical for determining long-term cognitive outcome in childhood-onset epilepsy. Few participants in remission exhibited marked cognitive impairment compared to age-matched peers. However, a subgroup of participants with decades long active epilepsy, continuous seizure activity and anti-epileptic drug (AED) medication, showed clinically significant cognitive impairment and are thus in a more precarious position when entering older age. (JINS, 2017, 23, 332–340)

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Pre-pregnancy Metabolic Syndrome on Short and Long-term Adverse Consequences for the Offspring: A Cohort Study of Low Income Brazilian Mothers

Placenta ◽

10.1016/j.placenta.2019.06.144 ◽

2019 ◽

Vol 83 ◽

pp. e44

Author(s):

Marilza Vieira Cunha Rudge ◽

Lucas Pontes de Camargo ◽

Mariana Alvarez Arantes ◽

Carlos Antonio Negrato ◽

Grasiela Bossolan ◽

...

Keyword(s):

Metabolic Syndrome ◽

Cohort Study ◽

Low Income ◽

Short And Long Term

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Identifying Influences on Catch-up Growth Using Relative versus Absolute Metrics: Evidence from the MAL-ED Study (P10-014-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-014-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Stephanie Richard ◽

Benjamin McCormick ◽

Laura Murray-Kolb ◽

Laura Caulfield

Keyword(s):

Linear Regression ◽

Relative Difference ◽

Maternal Height ◽

Z Score ◽

Linear Regression Models ◽

Negatively Associated ◽

Growth Standards ◽

Factors Associated ◽

Catch Up ◽

Protein Density

Abstract Objectives To identify factors associated with improvement (‘catch-up’) in height and weight from 24–60 mo of age, and to determine whether associated factors differ depending on the metric used (absolute or relative difference from WHO growth standards). Methods At seven MAL-ED sites, 942 children had anthropometry data at 24 and 60 mo, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9–24 mo, and micronutrient status. Anthropometric changes were categorized in terms of positive changes in Height- or Weight for-Age Z-score (HAZ, WAZ) or their differences (HAD, WAD) and recovery from stunting/underweight, and then modeled using multivariate linear regression. Results 42% of the children were stunted at 24 or 60 mo, and 24% of the children were underweight at 24 or 60 mo. 44% of the children who were stunted at 24 mo were not at 60 mo, and 34% of those underweight at 24 mo were no longer at 60 mo. Among the sites, 49–92% of children had positive changes in their HAZ, whereas 25–60% had positive changes in HAD. Linear regression models indicate that female sex (-0.21 HAZ (95% CI -0.27, -0.15); -0.75 HAD (95% CI -1.07, -0.43)) and mean LMZ (-0.10 HAZ (95% CI -0.16, -0.04); -0.47 HAD (95% CI -0.73, -0.21)) were negatively associated with change in both HAZ and HAD, whereas maternal height was positively associated with change in both HAZ and HAD (0.09 HAZ (95% CI 0.03, 0.15); 0.45 HAD (95% CI 0.15, 0.75)). Similar relationships were identified for change in WAZ and WAD. Dietary protein density was negatively associated with change in WAZ and WAD (-0.05 WAZ (95% CI -0.09, -0.01); -0.11 WAD (95% CI -0.21, -0.01)), and plasma transferrin receptor concentration was positively associated with change in WAZ and WAD (0.02 WAZ (95% CI 0.0, 0.04); 0.04 WAD (95% CI 0.0, 0.08)). Conclusions Children in the MAL-ED study demonstrated recovery from stunting and underweight from 24 to 60 mo of age. Given the similarities in the factors associated with changes in HAZ and HAD (and WAZ and WAD), both be used as complementary approaches to characterize and explain catch-up growth during early childhood. Funding Sources The MAL-ED study was supported by the Bill & Melinda Gates Foundation, with grants to the Foundation for the NIH and NIH/FIC.

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Postpartum plasma metabolomic profile among women with preeclampsia and preterm delivery: implications for long-term health

BMC Medicine ◽

10.1186/s12916-020-01741-4 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Xiumei Hong ◽

Boyang Zhang ◽

Liming Liang ◽

Yan Zhang ◽

Yuelong Ji ◽

...

Keyword(s):

Preterm Delivery ◽

Low Income ◽

Multiple Testing ◽

Plasma Metabolites ◽

Cardiometabolic Health ◽

Linear Regression Models ◽

High Risk Women ◽

Metabolomic Profiling ◽

Term Delivery

Abstract Background Preeclampsia and preterm delivery (PTD) are believed to affect women’s long-term health including cardiovascular disease (CVD), but the biological underpinnings are largely unknown. We aimed to test whether maternal postpartum metabolomic profiles, especially CVD-related metabolites, varied according to PTD subtypes with and without preeclampsia, in a US urban, low-income multi-ethnic population. Methods This study, from the Boston Birth Cohort, included 980 women with term delivery, 79 with medically indicated PTD (mPTD) and preeclampsia, 52 with mPTD only, and 219 with spontaneous PTD (sPTD). Metabolomic profiling in postpartum plasma was conducted by liquid chromatography-mass spectrometry. Linear regression models were used to assess the associations of each metabolite with mPTD with preeclampsia, mPTD only, and sPTD, respectively, adjusting for pertinent covariates. Weighted gene coexpression network analysis was applied to investigate interconnected metabolites associated with the PTD/preeclampsia subgroups. Bonferroni correction was applied to account for multiple testing. Results A total of 380 known metabolites were analyzed. Compared to term controls, women with mPTD and preeclampsia showed a significant increase in 36 metabolites, mainly representing acylcarnitines and multiple classes of lipids (diacylglycerols, triacylglycerols, phosphocholines, and lysophosphocholines), as well as a decrease in 11 metabolites including nucleotides, steroids, and cholesteryl esters (CEs) (P < 1.3 × 10−4). Alterations of diacylglycerols, triacylglycerols, and CEs in women with mPTD and preeclampsia remained significant when compared to women with mPTD only. In contrast, the metabolite differences between women with mPTD only and term controls were only seen in phosphatidylethanolamine class. Women with sPTD had significantly different levels of 16 metabolites mainly in amino acid, nucleotide, and steroid classes compared to term controls, of which, anthranilic acid, bilirubin, and steroids also had shared associations in women with mPTD and preeclampsia. Conclusion In this sample of US high-risk women, PTD/preeclampsia subgroups each showed some unique and shared associations with maternal postpartum plasma metabolites, including those known to be predictors of future CVD. These findings, if validated, may provide new insight into metabolomic alterations underlying clinically observed PTD/preeclampsia subgroups and implications for women’s future cardiometabolic health.

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Lower volume, more impairment: reduced cholinergic basal forebrain grey matter density is associated with impaired cognition in Parkinson disease

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-320450 ◽

2019 ◽

Vol 90 (11) ◽

pp. 1251-1256 ◽

Cited By ~ 10

Author(s):

Matthew J Barrett ◽

Scott A Sperling ◽

Jamie C Blair ◽

Cody S Freeman ◽

Joseph L Flanigan ◽

...

Keyword(s):

Parkinson Disease ◽

Basal Forebrain ◽

Grey Matter ◽

De Novo ◽

Neuropsychological Test ◽

Cognitive Outcomes ◽

Healthy Controls ◽

Z Score ◽

Linear Regression Models ◽

Cholinergic Basal Forebrain

ObjectiveA major contributor to dementia in Parkinson disease (PD) is degeneration of the cholinergic basal forebrain. This study determined whether cholinergic nucleus 4 (Ch4) density is associated with cognition in early and more advanced PD.MethodsWe analysed brain MRIs and neuropsychological test scores for 228 newly diagnosed PD participants from the Parkinson’s Progression Markers Initiative (PPMI), 101 healthy controls from the PPMI and 125 more advanced PD patients from a local retrospective cohort. Cholinergic basal forebrain nuclei densities were determined by applying probabilistic maps to MPRAGE T1 sequences processed using voxel-based morphometry methods. Relationships between grey matter densities and cognitive scores were analysed using correlations and linear regression models.ResultsIn more advanced PD, greater Ch4 density was associated with Montreal Cognitive Assessment (MoCA) score (β=14.2; 95% CI=1.5 to 27.0; p=0.03), attention domain z-score (β=3.2; 95% CI=0.8 to 5.5; p=0.008) and visuospatial domain z-score (β=7.9; 95% CI=2.0 to 13.8; p=0.009). In the PPMI PD cohort, higher Ch4 was associated with higher scores on MoCA (β=9.2; 95% CI=1.9 to 16.5; p=0.01), Judgement of Line Orientation (β=20.4; 95% CI=13.8 to 27.0; p<0.001), Letter Number Sequencing (β=16.5; 95% CI=9.5 to 23.4; p<0.001) and Symbol Digit Modalities Test (β=41.8; 95% CI=18.7 to 65.0; p<0.001). These same relationships were observed in 97 PPMI PD participants at 4 years. There were no significant associations between Ch4 density and cognitive outcomes in healthy controls.ConclusionIn de novo and more advanced PD, lower Ch4 density is associated with impaired global cognition, attention and visuospatial function.

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Long-term mortality in young and middle-aged adults hospitalised with chronic disease: a Danish cohort study

BMJ Open ◽

10.1136/bmjopen-2020-038131 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038131 ◽

Cited By ~ 1

Author(s):

Nils Skajaa ◽

Anne Gulbech Ording ◽

Bianka Darvalics ◽

Erzsebet Horvath-Puho ◽

Henrik Toft Sørensen

Keyword(s):

Cohort Study ◽

Chronic Disease ◽

General Population ◽

Chronic Diseases ◽

Low Income ◽

Years Of Life Lost ◽

Mortality Risks ◽

Risk Of Death ◽

Psychiatric Conditions

ObjectivesTo examine the long-term outcomes for patients hospitalised with chronic diseases at age 30, 40 or 50 years.DesignNationwide, population-based cohort study.SettingAll Danish hospitals, 1979–1989, with follow-up through 2014.ParticipantsPatients hospitalised during the study period with one, two or three or more chronic diseases and age-matched and sex-matched persons from the general population without chronic disease leading to hospitalisation: age-30 group: 13 857 patients and 69 285 comparators; age-40 group: 24 129 patients and 120 645 comparators; and age-50 group, 37 807 patients and 189 035 comparators.Main outcome measuresTwenty-five-year mortality risks based on Kaplan-Meier estimates, years-of-life-lost (YLLs) and mortality rate ratios based on Cox regression analysis. YLLs were computed for each morbidity level, as well as in strata of income, employment, education and psychiatric conditions.ResultsTwenty-five-year mortality risks and YLLs increased steadily with increasing number of morbidities leading to hospitalisation and age, but the risk difference with general population comparators remained approximately constant across age cohorts. In the age-30 cohort, the risk differences for patients compared with comparators were 35.0% (95% CI 32.5 to 37.5) with two diseases and 62.5% (54.3% to 70.3%) with three or more diseases. In the age-50 cohort, these differences were, respectively, 48.4% (47.4 to 49.3) and 61.7% (60.1% to 63.0%). Increasing morbidity burden augmented YLLs resulting from low income, unemployment, low education level and psychiatric conditions. In the age-30 cohort, YYLs attributable to low income were 2.4 for patients with one disease, 6.2 for patients with two diseases and 11.5 for patients with three or more diseases.ConclusionsAmong patients with multiple chronic diseases, the risk of death increases steadily with the number of chronic diseases and with age. Multimorbidity augments the already increased mortality among patients with low socioeconomic status.

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The longitudinal association between soybean and non-soybean legumes intakes and risk of cardiovascular disease: Isfahan cohort study

British Food Journal ◽

10.1108/bfj-08-2020-0699 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Fatemeh Nouri ◽

Fahimeh Haghighatdoost ◽

Noushin Mohammadifard ◽

Marjan Mansourian ◽

Masoumeh Sadeghi ◽

...

Keyword(s):

Cohort Study ◽

General Population ◽

Low Income ◽

Repeated Measures ◽

Cardiovascular Events ◽

Repeated Measurements ◽

Low Income Countries ◽

Content Type ◽

Longitudinal Association

PurposeThe associations between legume consumption and cardiovascular events (CVEs) have extensively been studied. However, there are few studies that considered longitudinal association between legume consumption (with repeated measurements across time) and CVEs in low-income countries where legume consumption is lower than the Western countries. The authors aimed to investigate the long-term longitudinal relationship between soybean, non-soybean and overall legume consumption and CVEs using repeated measures of legumes and time-varying confounders in a cohort study of the general population.Design/methodology/approachThe current study was performed within the framework of the Isfahan cohort study among 5,432 healthy participants. The participants were followed-up for fatal and non-fatal myocardial infarction, unstable angina, fatal and non-fatal stroke and sudden cardiac death for 13 years. Dietary intake was evaluated using a validated food frequency questionnaire in 2001, 2007 and 2013. The hazard ratios (HRs) and 95% confidence intervals (CI) for CVEs between categories of soybean, non-soybean and overall legumes intake were examined using marginal Cox's regression analysis.FindingsLong-term consumptions of overall legumes more than three times per week and non-soybean three times or more per week compared with those who had less than once a week were associated with 19.5% (HR = 0.805, 95% CI: 0.650,0.998; p < 0.048) and a 18.5% (HR = 0.815, 95% CI: 0.673, 0.988; p < 0.037) lower risk of CVEs in the general population, respectively. However, our findings revealed no significant reduction in CVEs following a higher intake of soybeans.Originality/valueIn the long run, even modest consumption of legumes, but not soybeans alone, can be effective to reduce CVEs risk in a low-income population. Further studies are warranted to confirm our results in other populations, examine the associations by the type of cardiovascular events and determine any possible threshold effects in this regard.

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Biomarkers of maternal environmental enteric dysfunction are associated with shorter gestation and reduced length in newborn infants in Uganda

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy176 ◽

2018 ◽

Vol 108 (4) ◽

pp. 889-896 ◽

Cited By ~ 4

Author(s):

Jacqueline M Lauer ◽

Christopher P Duggan ◽

Lynne M Ausman ◽

Jeffrey K Griffiths ◽

Patrick Webb ◽

...

Keyword(s):

Birth Outcomes ◽

Birth Outcome ◽

Newborn Infants ◽

Outcome Data ◽

Adverse Birth Outcomes ◽

Z Score ◽

Linear Regression Models ◽

Environmental Enteric Dysfunction ◽

Immunoglobin G

Abstract Background Adverse birth outcomes, including preterm birth and stunting at birth, have long-term health implications. The relation between adverse birth outcomes and chronic, asymptomatic gastrointestinal inflammation (environmental enteric dysfunction—EED) is poorly understood. Objective We aimed to examine the relation between maternal EED and adverse birth outcomes in a sample of pregnant Ugandan women and their newborn infants. Design We conducted a prospective cohort study in Mukono, Uganda. A total of 258 pregnant women were enrolled at their first prenatal visit (∼18 weeks of gestation). EED was measured by urinary lactulose:mannitol (L:M) ratio and serum concentrations of antibodies to the bacterial components flagellin and LPS. Covariates were obtained from survey data collected at 2 time points. Associations were assessed through the use of unadjusted and adjusted simple linear regression models. Results Complete birth outcome data were recorded for 220 infants within 48 h of delivery. Mean ± SD gestational age was 39.7 ± 2.1 wk, and 7% were born preterm. Mean ± SD length and length-for-age z score (LAZ) at birth were 48.1 ± 3.2 cm and −0.44 ± 1.07, respectively. L:M ratio was not associated with any birth outcome. In adjusted models, higher concentrations of natural log-transformed anti-flagellin immunoglobin G (IgG) and anti-LPS IgG were significantly associated with shorter length of gestation (β: −0.89 wk; 95% CI: −1.77, −0.01 wk, and β: −1.01 wk; 95% CI: −1.87, −0.17 wk, respectively) and with reduced length (β: −0.80 cm; 95% CI: −1.55, −0.05 cm, and β: −0.79 cm; 95% CI: −1.54, −0.04 cm, respectively) and LAZ at birth (β −0.44 z score; 95% CI: −0.83, −0.05, and β: −0.40 z score; 95% CI: −0.79, −0.01, respectively). Conclusion Maternal anti-flagellin and anti-LPS IgG concentrations in pregnancy, but not L:M ratio, were associated with shorter gestation and reduced infant length at birth. Further research on the relation between maternal EED and birth outcomes is warranted.

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