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      Causes and consequences of child growth faltering in low-resource settings

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          Abstract

          Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival 1, 2 . Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.

          Abstract

          Analysis of data from 33 longitudinal cohorts from low- and middle-income countries indicates that conditions during pre-conception, pregnancy and the first few months of life are crucial in determining the risk of growth faltering in young children.

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          Regression Shrinkage and Selection Via the Lasso

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            Maternal and child undernutrition and overweight in low-income and middle-income countries

            The Lancet, 382(9890), 427-451
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                Author and article information

                Contributors
                amertens@berkeley.edu
                ben.arnold@ucsf.edu
                Journal
                Nature
                Nature
                Nature
                Nature Publishing Group UK (London )
                0028-0836
                1476-4687
                13 September 2023
                13 September 2023
                2023
                : 621
                : 7979
                : 568-576
                Affiliations
                [1 ]Division of Epidemiology and Biostatistics, University of California, Berkeley, ( https://ror.org/05t99sp05) Berkeley, CA USA
                [2 ]Department of Epidemiology and Population Health, Stanford University, ( https://ror.org/00f54p054) Stanford, CA USA
                [3 ]Chan Zuckerberg Biohub, ( https://ror.org/00knt4f32) San Francisco, CA USA
                [4 ]DVPL Tech, Dubai, United Arab Emirates
                [5 ]Hafen Consulting, West Richland, WA USA
                [6 ]Cytel, ( https://ror.org/01ftkxq60) Waltham, MA USA
                [7 ]Quantitative Sciences, Bill & Melinda Gates Foundation, ( https://ror.org/0456r8d26) Seattle, WA USA
                [8 ]GRID grid.27860.3b, ISNI 0000 0004 1936 9684, Department of Nutrition, , University of California, Davis, ; Davis, CA USA
                [9 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Center for Human Nutrition, Department of International Health, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA
                [10 ]Francis I. Proctor Foundation, University of California, San Francisco, ( https://ror.org/05t99sp05) San Francisco, CA USA
                [11 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Department of Ophthalmology, , University of California, San Francisco, ; San Francisco, CA USA
                [12 ]Food Safety and Nutrition Unit, Department of Public Health and Primary Care, Ghent University, ( https://ror.org/00cv9y106) Ghent, Belgium
                [13 ]University of North Carolina at Chapel Hill, ( https://ror.org/0130frc33) Chapel Hill, NC USA
                [14 ]International Centre for Diarrhoeal Disease Research, ( https://ror.org/04vsvr128) Dhaka, Bangladesh
                [15 ]Aga Khan University, ( https://ror.org/03gd0dm95) Karachi, Pakistan
                [16 ]JiVitA Project, Johns Hopkins Bangladesh, Bangladesh, Rangpur, Bangladesh
                [17 ]Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, ( https://ror.org/033003e23) Tampere, Finland
                [18 ]World Health Organization, ( https://ror.org/01f80g185) Geneva, Switzerland
                [19 ]Center of Data and Knowledge Integration for Health, Fundação Oswaldo Cruz, ( https://ror.org/04jhswv08) Salvador, Brazil
                [20 ]International Food Policy Research Institute, ( https://ror.org/03pxz9p87) Washington, DC USA
                [21 ]GRID grid.420318.c, ISNI 0000 0004 0402 478X, UNICEF, ; New York, NY USA
                [22 ]HIV/AIDS and Global Health Research Programme, University of Venda, ( https://ror.org/0338xea48) Thohoyandou, South Africa
                [23 ]Indian Institute of Technology, ( https://ror.org/049tgcd06) New Delhi, India
                [24 ]Centre for Health Research and Development, Society for Applied Studies, ( https://ror.org/00x817z51) New Delhi, India
                [25 ]Sunder Lal Jain Hospital, ( https://ror.org/01x87db24) Delhi, India
                [26 ]Institute for Global Health and Development and Center of Excellence in Women and Child Health, The Aga Khan University, ( https://ror.org/03gd0dm95) Karachi, Pakistan
                [27 ]Bloomberg School of Public Health, Johns Hopkins University, ( https://ror.org/00za53h95) Baltimore, MD USA
                [28 ]Armed Forces Research Institute of Medical Sciences, ( https://ror.org/023swxh49) Bangkok, Thailand
                [29 ]USC Office of Population Studies Foundation, University of San Carlos, ( https://ror.org/041jw5813) Cebu, Philippines
                [30 ]Bill & Melinda Gates Foundation, ( https://ror.org/0456r8d26) Seattle, WA USA
                [31 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, Leeds Institute for Medical Research, St James’s University Hospital, , University of Leeds, ; Leeds, UK
                [32 ]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, Institute for Global Nutrition, Department of Nutrition, , University of California, ; Los Angeles, CA USA
                [33 ]Center for Nutrition, Boston Children’s Hospital, ( https://ror.org/00dvg7y05) Boston, MA USA
                [34 ]MRC Lifecourse Epidemiology Centre, University of Southampton, ( https://ror.org/01ryk1543) Southampton, UK
                [35 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Global Health and Population, , Harvard TH Chan School of Public Health, ; Cambridge, MA USA
                [36 ]Federal University of Ceará, ( https://ror.org/03srtnf24) Fortaleza, Brazil
                [37 ]University of Virginia, ( https://ror.org/0153tk833) Charlottesville, VA USA
                [38 ]Department of Pediatrics and Child Health, Aga Khan University, ( https://ror.org/03gd0dm95) Karachi, Pakistan
                [39 ]Departments of Pediatrics, University of New Mexico Health Sciences Center, ( https://ror.org/05fs6jp91) Albuquerque, NM USA
                [40 ]Department of Internal Medicine, University of New Mexico Health Sciences Center, ( https://ror.org/05fs6jp91) Albuquerque, NM USA
                [41 ]Christian Medical College, ( https://ror.org/01vj9qy35) Vellore, India
                [42 ]Translational Health Science and Technology Institute, ( https://ror.org/01qjqvr92) Faridabad, India
                [43 ]McGill University and McGill University Health Centre, ( https://ror.org/01pxwe438) Quebec, Quebec Canada
                [44 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Center of Human Nutrition, Department of International Health, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA
                [45 ]Office of Population Studies Foundation, University of San Carlos, ( https://ror.org/041jw5813) Cebu, Philippines
                [46 ]Department of Nutrition, School of Health Sciences, University of Venda, ( https://ror.org/0338xea48) Thohoyandou, South Africa
                [47 ]Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, ( https://ror.org/04vtx5s55) Zomba, Malawi
                [48 ]Mother and Infant Research Activities, ( https://ror.org/05b0j5x36) Kathmandu, Nepal
                [49 ]GRID grid.25867.3e, ISNI 0000 0001 1481 7466, Department of Pediatrics and Child Health, , Muhimbili University School of Health and Allied Sciences, ; Dar es Salaam, Tanzania
                [50 ]Rollins School of Public Health, Emory University, ( https://ror.org/03czfpz43) Atlanta, GA USA
                [51 ]Haydom Lutheran Hospital, ( https://ror.org/02tzc1925) Haydom, Tanzania
                [52 ]Community Medicine, Christian Medical College, ( https://ror.org/01vj9qy35) Vellore, India
                [53 ]Department of Women and Children’s Health, Kings College London, ( https://ror.org/0220mzb33) London, UK
                [54 ]GRID grid.415063.5, ISNI 0000 0004 0606 294X, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, ; Banjul, The Gambia
                [55 ]Zvitambo Institute for Maternal and Child Health Research, ( https://ror.org/029qzhb32) Harare, Zimbabwe
                [56 ]Department of Animal Sciences, School of Agriculture, University of Venda, ( https://ror.org/0338xea48) Thohoyandou, South Africa
                [57 ]GRID grid.420007.1, ISNI 0000 0004 1761 624X, AB PRISMA, ; Lima, Peru
                [58 ]Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, ( https://ror.org/03wzeak38) Guatemala City, Guatemala
                [59 ]Sitaram Bhartia Institute of Science and Research, ( https://ror.org/026a3nk20) New Delhi, India
                [60 ]Institute for Global Health, University College London, ( https://ror.org/02jx3x895) London, UK
                [61 ]Health Research and Development Forum, Kathmandu, Nepal
                [62 ]Walter Reed/AFRIMS Research Unit, Kathmandu, Nepal
                [63 ]Centre for International Health, University of Bergen, ( https://ror.org/03zga2b32) Bergen, Norway
                [64 ]Hubert Department of Global Health, Rollins School of Public Health, Emory University, ( https://ror.org/03czfpz43) Atlanta, GA USA
                [65 ]Haukeland University Hospital, ( https://ror.org/03np4e098) Bergen, Norway
                [66 ]Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Virginia School of Medicine, ( https://ror.org/0153tk833) Charlottesville, VA USA
                [67 ]GRID grid.429997.8, ISNI 0000 0004 1936 7531, Tufts Medical Center, , Tufts University School of Medicine, ; Medford, MA USA
                [68 ]McGill University, ( https://ror.org/01pxwe438) Quebec, Canada
                Author information
                http://orcid.org/0000-0002-1050-6721
                http://orcid.org/0000-0003-3631-3132
                http://orcid.org/0000-0002-9874-6649
                http://orcid.org/0000-0002-3769-0127
                http://orcid.org/0000-0002-7404-8088
                http://orcid.org/0000-0002-7127-2789
                http://orcid.org/0000-0002-2211-9040
                http://orcid.org/0000-0002-9901-671X
                http://orcid.org/0000-0003-4629-4668
                http://orcid.org/0000-0001-5073-8749
                http://orcid.org/0000-0002-5516-8367
                http://orcid.org/0000-0001-8304-9528
                http://orcid.org/0000-0001-6105-7295
                Article
                6501
                10.1038/s41586-023-06501-x
                10511328
                37704722
                8157271d-f4da-4de9-aac9-93a74bca4a0e
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 9 June 2020
                : 31 July 2023
                Categories
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                Custom metadata
                © Springer Nature Limited 2023

                Uncategorized
                malnutrition,epidemiology,risk factors,developing world
                Uncategorized
                malnutrition, epidemiology, risk factors, developing world

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