Stunting in infancy, pubertal trajectories and adult body composition: the Birth to Twenty Plus cohort, South Africa

Impact of Small-Quantity Lipid-Based Nutrient Supplements on Pubertal Status of 9-13-Year Olds: A Follow-Up Study of the iLiNS-DYAD-Ghana Trial

Background

Early and delayed puberty are both associated with adverse health and psychosocial outcomes.

Objectives

We assessed the impact of provision of small-quantity lipid-based nutrient supplement (SQ-LNS) to mothers during pregnancy and 6 mo postpartum and to their children aged 6-18 mo, on pubertal status.

Methods

This study was a follow-up to a partially double-blind randomized controlled trial. At ≤20 wk, 1320 females were randomly assigned to receive daily: iron and folic acid during pregnancy and placebo 0-6 mo postpartum; or multiple micronutrients during pregnancy and 0-6 mo postpartum; or SQ-LNS during pregnancy and 0-6 mo postpartum and to their children from 6 to 18 mo. We re-enrolled 966 and 919 children at 9-11 y and 11-13 y, respectively. We calculated a total pubertal status score based on the Petersen Pubertal Development Scale (PDS) to assess growth spurt, skin changes, body hair, facial hair, voice break, breast development, and menstruation. Pubertal status was regressed on child's age to generate age-adjusted PDS z-scores (aPDSZ); we performed interaction and mediation analyses.

Results

Mean ± standard deviation aPDSZ did not differ between the SQ-LNS and non-LNS groups at 9-11 y (0.01 ± 0.95 compared with -0.01 ± 0.98; P = 0.958) but was more advanced in the SQ-LNS group at 11-13 y (0.07 ± 1.04 compared with -0.04 ± 0.98; P = 0.049) in the adjusted model. The effect of SQ-LNS varied by sex (P-interaction = 0.003) and household asset index z-score (P-interaction = 0.002): Puberty was more advanced in the SQ-LNS compared with non-LNS group among females (P = 0.007) but not males (P = 0.877), and within lower (P = 0.002) than average (P = 0.436) and higher (P = 0.332) socioeconomic households.

Conclusion

Provision of SQ-LNS during the first 1000 d of life advanced pubertal status among females.

Trial registration number

This trial was registered at clinicaltrials.gov as NCT00970866 (https://clinicaltrials.gov/ct2/show/record/NCT00970866).

Anthropometric status, body composition and timing of pubertal milestones in Sub-Saharan Africa: a systematic review

BACKGROUND

With the rise of the triple burden of malnutrition, the changing nutrition situation in Sub-Saharan Africa may be associated with changes in pubertal timing of adolescents. The purpose of this review was to summarize the association between nutritional status and pubertal milestones among children in SSA.

METHOD

A search of publications was conducted in PubMed and Scopus on 1st April 2023. Observational studies with children aged 0 to 22 years, that reported nutritional status and association with pubertal milestones in SSA were selected for review. Risk of bias was assessed using the NOS and results were presented using the PRISMA.

RESULTS

Twenty-three studies published from 1992 to 2021 reporting data from nine countries and a total of 21,853 children were included in this review. Mean menarche age relative to nutritional status varied from 17.2 years in stunted adolescents in Senegal to 13.3 (in the underweight), 13.9 (in normal weight girls), and 14.1 (in overweight girls) years in adolescents in Ethiopia. Adolescents who were not stunted in Kenya and those with higher height-for-age z-scores (HAZ) and body mass index (BMI) in South Africa had more advanced breast development. Pubic hair development was positively associated with HAZ and BMI z-scores (BMIZ) at 5 years in South Africa and overweight and obesity in adolescents in Nigeria. Attainment of voice break in adolescent boys in Nigeria was associated with lower likelihood of stunting and underweight. In a study in Zambia, earlier onset and more rapid progression of genital development assessed by testicular volume in boys was associated with increased height and arm muscle.

CONCLUSIONS

Higher BMI, height, weight, and triceps skinfolds are significantly associated with advanced pubertal development in SSA. In SSA, less than one-third of the countries have published any research studies on nutritional status and pubertal milestones. Future studies should focus on detailed assessment of pubertal development and associated nutritional factors in both male and female adolescents in SSA.

PROSPERO REGISTRATION

CRD42022350048.

Landscape Fire Air Pollution as a Mediator in Drought and Childhood Stunting Pathway in Low- and Middle-Income Countries

Drought induces dry hazards, including wildfire, and increased air pollution from wildfire may be a mechanism by which drought increases health risks. We examined whether the drought-wildfire pathway increases the risk of childhood stunting. We analyzed all geocoded children under five across 44 low- and middle-income countries (LMICs). We first conducted mixed-effect regressions to examine the three pairwise associations between standardized precipitation evapotranspiration index (SPEI), fire-sourced PM2.5, and childhood stunting. We then employed a causal mediation analysis to determine whether compounding drought-wildfire (cascading or co-occurring) events significantly impact the drought-stunting pathway. We found that each 1-unit decrease in SPEI exposure was associated with a 2.16% [95% confidence interval (CI): 0.79, 3.49%] increase in stunting risk and 0.57 (95% CI 0.55, 0.59%) μg/m3 increase in fire-sourced PM2.5. Additionally, each 1 μg/m3 increase in 24 month average fire-sourced PM2.5 was associated with an increased risk of 2.46% (95% CI: 2.16, 2.76%) in stunting. Drought-mediated fires accounted for 26.7% (95% CI: 14.5, 36.6%) of the linkage between SPEI and stunting. Our study revealed fire-sourced PM2.5 is a mediator in the drought-stunting pathway in LMICs. To protect child health under increasing drought conditions, personal interventions against wildfire should be considered to enhance climate resilience.

Growth Profiles of Children and Adolescents Living with and without Perinatal HIV Infection in Southern Africa: A Secondary Analysis of Cohort Data

Impaired linear growth and slower pubertal growth can be associated with perinatal HIV infection. We characterised growth relative to population norms, among the full adolescent period in southern Africa to better understand processes leading to morbidity in adulthood. We conducted a secondary analysis of 945 adolescents aged 8-20 years from urban Malawi and Zimbabwe; we included children with HIV (CWH), an uninfected comparison group from a cohort study, and CWH with co-morbid chronic lung disease (CLD) from a randomised controlled trial. We used latent class analysis of anthropometric Z-scores generated from British 1990 reference equations at two annual time-points, to identify growth trajectory profiles and used multinomial logistic regression to identify factors associated with growth profiles. Growth faltering (one or more of weight-for-age, height-for-age, or BMI-for-age Z-scores < -2) occurred in 38% (116/303) of CWH from the cohort study, 62% (209/336) of CWH with CLD, and 14% (44/306) of HIV-uninfected participants. We identified seven different growth profiles, defined, relatively, as (1) average growth, (2) tall not thin, (3) short not thin, (4) stunted not thin, (5) thin not stunted, (6) thin and stunted and (7) very thin and stunted. Females in profile 3 exhibited the highest body fat percentage, which increased over 1 year. Males at older age and CWH especially those with CLD were more likely to fall into growth profiles 4-7. Improvements in height-for-age Z-scores were observed in profiles 6-7 over 1 year. Interventions to target those with the worst growth faltering and longer-term follow-up to assess the impact on adult health are warranted.

What values drive communities' nutrition priorities in a resource constrained urban area in South Africa?

BACKGROUND

Voices of under-resourced communities are recognised as important yet are often unheard in decisions about healthcare resource allocation. Deliberative public engagement can serve as an effective mechanism for involving communities in establishing nutrition priorities. This study sought to identify the priorities of community members of a South African township, Soweto, and describe the underlying values driving their prioritisation process, to improve nutrition in the first 1000 days of life.

METHODS

We engaged 54 community members (28 men and 26 women aged > 18 years) from Soweto. We conducted seven group discussions to determine how to allocate limited resources for prioritising nutrition interventions. We used a modified public engagement tool: CHAT (Choosing All Together) which presented 14 nutrition intervention options and their respective costs. Participants deliberated and collectively determined their nutritional priorities. Choices were captured quantitatively, while group discussions were audio-recorded. A thematic analysis was undertaken to identify the reasons and values associated with the selected priorities.

RESULTS

All groups demonstrated a preference to allocate scarce resources towards three priority interventions-school breakfast provisioning, six-months paid maternity leave, and improved food safety. All but one group selected community gardens and clubs, and five groups prioritised decreasing the price of healthy food and receiving job search assistance. Participants' allocative decisions were guided by several values implicit in their choices, such as fairness and equity, efficiency, social justice, financial resilience, relational solidarity, and human development, with a strong focus on children. Priority interventions were deemed critical to supporting children's optimal development and well-being, interrupting the intergenerational cycle of poverty and poor human development in the community.

CONCLUSION

Our study demonstrates how public engagement can facilitate the incorporation of community values and programmatic preferences into nutrition priority setting, enabling a responsive approach to local community needs, especially in resource constrained contexts. Findings could guide policy makers to facilitate more appropriate decisions and to improve nutrition in the first 1000 days of life.

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

Early‐life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early‐life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross‐sectional sample of 6‐year‐olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early‐life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural‐urban differences in demographic, socioeconomic, early‐life, and anthropometric variables, then created linear mixed models to evaluate associations between early‐life variables and child anthropometric outcomes. Two‐way interactions were tested between early‐life variables and child sex, and between early‐life variables and rural‐urban residence. Results showed that rural children were shorter‐statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6‐year‐old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early‐life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.

Does birth season correlate with childhood stunting? An input for astrological nutrition

INTRODUCTION

Chronic malnutrition is highly prevalent in Sub-Saharan Africa and a severe public health problem in Ethiopia.At country level in the past three decades,the prevalence of stunting is above 40%.Different researchs and intervention were implemented in the past;but the progresss is non-remarkable.Despite; the effect of birth season on childhood chronic malnutrition was not studied yet in Ethiopia.

METHODS

This research was extracted from the 2016 demographic health survey of Ethiopia. The data was collected based on national and international scientific protocols. A total of 645 enumeration areas were selected for the national survey.The surevey uses two stage stratified sampling technique to gather data from the sampling unit. After excluding non eligible children a total of 8855 participants were included for final analysis.Height and weight were measured based on the standards nutritional assessment procedure.SPSS version 20 was used to analyze the data.Descriptive statistics were used to present the data. Binary and multivariable logistic regression models were regressed to identify the potential predictors.A p-value of less than 0.05 with 95% CI were used to declare an association.

RESULT

The prevalence of stunting in Ethiopia was 38.7% (95% CI: 36.8, 40.6). Season of birth had a significant association with stunting. The odds of being stunted among children born in the spring season were decreased by 16% as compared to children born in the winter season.

CONCLUSION

Children born in the spring season were less likely to be stunted (the so called October effect). The clear scientific relation between the season of birth and child anthropometric indicator is not well understood. Nutritional interventions and policies are better to consider the birth season of the child.

Timing of Pubertal Development in Boys and Girls With Congenital Heart Defects: A Nationwide Cohort Study

Background

Children with congenital heart defects (CHD) have an increased risk of developmental delay. It remains sparsely investigated if these patients also have a delayed pubertal development. In this nationwide cohort study, we evaluated if CHD was associated with timing of puberty using longitudinally collected data on pubertal milestones.

Methods and Results

We used data from the Danish nationwide Puberty Cohort. Information on CHD was obtained from the Danish National Patient Register. Information on pubertal development was obtained from 15 780 children through questionnaires answered half‐yearly from 11 years until 18 years or full maturity. Using a multivariable regression model for censored time‐to‐event data, mean difference in age at attaining each pubertal milestone was estimated, including a combined pubertal marker. Compared with children without CHD, analyses were performed for both CHD overall and subdivided into simple and complex CHD. In a subanalysis, analyses were repeated in children born at term. In total, 137 children (62 boys and 75 girls) had a CHD diagnosis. Overall, no difference in age at pubertal timing was observed for children with CHD compared with unaffected children. The average differences were small for both boys (1.6 [95% CI, −2.6 to 5.7] months) and girls (1.0 [95% CI, −2.5 to 4.4] months). The same differences were observed when subdividing into simple or complex CHD and when restricting to children born at term.

Conclusions

We found no association between CHD and pubertal timing. For the group of children with complex CHD, we were unable to exclude a later pubertal timing.

A growth area: A review of the value of clinical studies of child growth for palaeopathology

Studies of living children demonstrate that early life stress impacts linear growth outcomes. Stresses affecting linear growth may also impact later life health outcomes, including increased cardiometabolic disease risk. Palaeopathologists also assess the growth of children recovered from bioarchaeological contexts. Early life stresses are inferred to affect linear growth outcomes, and measurements of skeletal linear dimensions alongside other bioarchaeological information may indicate the types of challenges faced by past groups. In clinical settings, the impacts of stress on growing children are typically measured by examining height. Palaeopathologists are limited to examining bone dimensions directly and must grapple with incomplete pictures of childhood experiences that may affect growth. Palaeopathologists may use clinical growth studies to inform observations among past children; however, there may be issues with this approach. Here, we review the relationship between contemporary and palaeopathological studies of child and adolescent growth. We identify approaches to help bridge the gap between palaeopathological and biomedical growth studies. We advocate for: the creation of bone-specific growth reference information using medical imaging and greater examination of limb proportions; the inclusion of children from different global regions and life circumstances in contemporary bone growth studies; and greater collaboration and dialogue between palaeopathologists and clinicians as new studies are designed to assess linear growth past and present. We advocate for building stronger bridges between these fields to improve interpretations of growth patterns across human history and to potentially improve interventions for children living and growing today.

Stunting among kindergarten children in China in the context of COVID-19: A cross-sectional study

BACKGROUND

The impact of COVID-19 has most likely increased the prevalence of stunting. The study aimed to determine the prevalence of stunting among kindergarten children in the context of coronavirus disease 2019 (COVID-19) in Longgang District, Shenzhen, China, and its risk factors.

METHODS

A cross-sectional study was conducted to identify children from 11 sub districts of 481 kindergartens in the Longgang District of Shenzhen City from May to July 2021. In the context of COVID-19, an online survey was conducted to gather demographic information, height, birth information, and lifestyle. The prevalence of stunting was calculated, and the risk factors were analyzed using binary logistic regression with three stepwise models.

RESULTS

A total of 118,404 subjects were included from May to July 2021, with a response and questionnaire effective rates of 85.75% and 95.03%, respectively. The prevalence of stunting and severe stunting were 3.3% and 0.8%, respectively. Model 3 showed that risk factors for stunting were male sex [odds ratio (OR) = 1.07], low birth weight (OR = 2.02), insufficient sleep time (OR = 1.08), less food intake than their peers (OR = 1.66), slower eating than their peers (OR = 1.16), accompanied by grandparents alone or non-lineal relatives (reference: parents accompanying) (OR = 1.23, 1.51), and children induced to eat (OR = 1.17). Protective factors included only-child status (OR = 0.66), reported high activity (OR = 0.37, 0.26, 0.23), parents with high education levels (father: OR = 0.87, 0.69; mother: OR = 0.69, 0.58), high monthly income per capita of the family (OR = 0.88, 0.74, 0.68), and allowing children to make food choices (OR = 0.82).

CONCLUSION

The stunting rate of children in kindergartens in Longgang District is 3.3%, close to the level of developed countries but higher than the average level of developed cities in China. The relatively high stunting rate in children under 3 years old in 2021 may be associated with the influence of COVID-19. Appropriate policies should be formulated for individuals and families with children to help children establish good living habits and reduce stunting.