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Rezaeizadeh G, Mansournia MA, Keshtkar A, Farahani Z, Zarepour F, Sharafkhah M, Kelishadi R, Poustchi H. Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis. EClinicalMedicine 2024; 71:102574. [PMID: 38596614 PMCID: PMC11001623 DOI: 10.1016/j.eclinm.2024.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Background The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies. Methods Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated. Findings The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301-0.496) and HAZ (MD 0.388, 95% CI 0.102-0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078-0.294) and HAZ (0.200, 95% CI 0.036-0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD -0.028, 95% CI -0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD -0.045, 95% CI -0.079 to -0.011) but not in highly educated populations (MD 0.003, 95% CI -0.093 to 0.098). Interpretation Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better. Funding This study was a student thesis supported financially by Tehran University of Medical Sciences (TUMS).
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Affiliation(s)
- Golnaz Rezaeizadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbasali Keshtkar
- Department of Disaster and Emergency Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Farahani
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zarepour
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Department of Paediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Zhou Y, Zhou J, He Y, Fang J, Tang J, Li S, Guo J, Luo Q, Zhong K, Huang K, Chen G. Associations between prenatal metal exposure and growth rate in children: Based on Hangzhou Birth Cohort Study. Sci Total Environ 2024; 916:170164. [PMID: 38242450 DOI: 10.1016/j.scitotenv.2024.170164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND It has been reported that prenatal metal exposure is associated with child anthropometry. However, studies focusing on the growth rate of anthropometry among children have not been conducted. This study aimed to examine associations between the exposure of multiple metals during pregnancy and the growth rate of anthropometry among offspring. METHODS 743 mother-child pairs from the Hangzhou Birth Cohort Study (HBCS) were included. Levels of eleven metals in mother's blood during pregnancy were measured. Offspring had a mean of 5.7 measurements on anthropometric indicators including weight, length/height, head circumference, and body mass index (BMI) within 1.5 years of birth. Generalized estimating equation (GEE) model was used to investigate the associations between maternal metal exposure and growth rate of anthropometric indicators in children. Stratification analysis by sex was also examined. RESULTS Levels of selenium (Se, β = 0.213, 95 % CI = 0.017 to 0.409, P = 0.033) were positively associated with length/height gain per month in children. Levels of chromium (Cr, β = 0.025, 95 % CI = 0.018 to 0.033, P < 0.001) were positively associated with the rate of weight gain. Levels of manganese (Mn, β = -0.030, 95 % CI = -0.052 to -0.008, P = 0.009) and cobalt (Co, β = -0.012, 95 % CI = -0.024 to -0.000, P = 0.044) were inversely associated with growth rate of head circumference. Children with higher maternal Mn levels had a lower BMI change rate. Associations between metals and growth rate were stronger in girls than in boys. Besides, significant associations between metal mixtures and growth rate were found. CONCLUSION Prenatal exposure to Se, Cr, Mn, and Co was associated with growth rate in children, with sex-specific disparities. Our results suggested important effects of maternal exposure to multiple metals on development in offspring.
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Affiliation(s)
- Yexinyi Zhou
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Jiena Zhou
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Yinyin He
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Jiawei Fang
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Jun Tang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310052, China
| | - Shuai Li
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
| | - Jing Guo
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
| | - Kunhong Zhong
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Kegui Huang
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Guangdi Chen
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China.
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Liu Y, Chen H, Zhou Y, Lin X, Yang L, Zhan B, Wei Y, Sun R, Yang H, Zhang Z, Deng G. The association of serum toxic metals and essential elements during early pregnancy with body mass index trajectory of infants during the first years: A prospective study. Ecotoxicol Environ Saf 2024; 269:115766. [PMID: 38039855 DOI: 10.1016/j.ecoenv.2023.115766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
To the best of our knowledge, prior research has yet to delve into the combined and interactive relationships between maternal exposure to essential elements and toxic metals and infancy's continuous growth and trajectories. This study aims to discern infant growth trajectories in the first year of life and to determine the associations of maternal serum levels of essential elements and toxic metals with growth trajectory. Within a Chinese prospective cohort in 2019 - 2021, 407 mother-infant pairs were included, and the serum levels of five essential elements (zinc, calcium, copper, magnesium and iron) and two toxic metals (cadmium and lead) in early pregnancy were assessed. The growth trajectory of infants was followed until age one year. Raw BMI and height values were transformed to age- and sex-specific BMI and height standard deviation (SD) scores. Latent-class group-based trajectory models and piecewise linear mixed regression were estimated to determine infant growth trajectories and growth velocity, respectively. The individual relationship between maternal metallic element levels and infant growth trajectory was examined using multinomial logistic regression models and linear mixed regression, while joint associations and interactive relationships were explored using Bayesian kernel machine regression (BKMR) following confounder adjustments. Four distinct trajectory patterns based on BMI-z score (low-rapid BMI gain group, normal-stable BMI group, very low-rapid BMI gain group and normal-rapid BMI gain group) and length-for-age (high-stable length group, low-stable length group, normal-rapid length gain group, very low-rapid length gain group) were identified during the first year post-birth, respectively. In single-metal and multiple-metal models, infants born to mothers with higher serum Zn and lower serum Cu levels were associated with a normal-rapid BMI gain trajectory during the first year. Serum Cu exhibited a positive correlation with the rate of BMI change solely in infants aged 6-12 months. Further, the BKMR analysis revealed a statistically significant and negative joint effect of the five essential elements on the likelihood of normal-rapid BMI/length gain trajectory when serum levels of these elements fell below the 70th percentile compared to median levels. In addition, high levels of serum copper and calcium interactively affect the rates of BMI change during 6-12 months old (β: -0.21, 95% CI: -0.44, -0.03, P = 0.04, P-interaction=0.04). In conclusion, maternal trace elements at early pregnancy are linked to infant growth patterns and growth velocity in the first year of life.
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Affiliation(s)
- Yao Liu
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China
| | - Hengying Chen
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Yingyu Zhou
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510080, People's Republic of China
| | - Xiaoping Lin
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510080, People's Republic of China
| | - Lanyao Yang
- School of Public Health, Ningxia Medical University, Yinchuan 750004, Ningxia, People's Republic of China
| | - Bowen Zhan
- School of Public Health, Ningxia Medical University, Yinchuan 750004, Ningxia, People's Republic of China
| | - Yuanhuan Wei
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510000, People's Republic of China
| | - Ruifang Sun
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510000, People's Republic of China
| | - Hongguang Yang
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China
| | - Zheqing Zhang
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510080, People's Republic of China
| | - Guifang Deng
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China.
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Monteith H, Mamakeesick M, Rae J, Galloway T, Harris SB, Birken C, Hamilton J, Maguire JL, Parkin P, Zinman B, Hanley AJG. Determinants of Anishinabeck infant and early childhood growth trajectories in Northwestern Ontario, Canada: a cohort study. BMC Pediatr 2023; 23:641. [PMID: 38115010 PMCID: PMC10729431 DOI: 10.1186/s12887-023-04449-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The Developmental Origins of Health and Disease (DOHaD) paradigm emphasizes the significance of early life factors for the prevention of chronic health conditions, like type 2 diabetes (T2DM) and obesity, which disproportionately affect First Nations communities in Canada. Despite increasing DOHaD research related to maternal health during pregnancy, early childhood growth patterns, and infant feeding practices with many populations, data from First Nations communities in Canada are limited. In partnership with Sandy Lake First Nation, the aims of this project were to characterize birthweights and growth patterns of First Nations infants/children over the first 6 years of life and to study the impact of maternal and infant social and behavioral factors on birthweight and growth trajectories. METHODS We recruited 194 families through community announcements and clinic visits. Infant/child length/height and weight were measured at 1 and 2 weeks; 1, 2, 6, 12, and 18 months; and 2, 3, 4, 5 and 6 years. Maternal and infant/child questionnaires captured data about health, nutrition, and social support. Weight-for-Age z-score (WAZ), Height-for-Age z-score (HAZ), and BMI-for-Age z-score (BAZ) were calculated using WHO reference standards and trajectories were analyzed using generalized additive models. Generalized estimating equations and logistic regression were used to determine associations between exposures and outcomes. RESULTS WAZ and BAZ were above the WHO mean and increased with age until age 6 years. Generalized estimating equations indicated that WAZ was positively associated with age (0.152; 95% CI 0.014, 0.29), HAZ was positively associated with birthweight (0.155; 95% CI 0.035, 0.275), and BAZ was positively associated with caregiver's BMI (0.049; 95% CI 0.004, 0.090). There was an increased odds of rapid weight gain (RWG) with exposure to gestational diabetes (OR: 7.47, 95% CI 1.68, 46.22). Almost 70% of parents initiated breastfeeding, and breastfeeding initiation was modestly associated with lower WAZ (-0.18; 95% CI -0.64, 0.28) and BAZ (-0.23; 95% CI -0.79, 0.34). CONCLUSIONS This work highlights early life factors that may contribute to T2DM etiology and can be used to support community and Indigenous-led prevention strategies.
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Affiliation(s)
- Hiliary Monteith
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical Sciences Building, 5Th Floor, Room 5253A, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | | | - Joan Rae
- Sandy Lake First Nation, Sandy Lake, ON, P0V 1V0, Canada
| | - Tracey Galloway
- Department of Anthropology, University of Toronto Mississauga Campus, Terrence Donnelly Health Sciences Complex, Room 354, 3359 Mississauga Rd, Mississauga, ON, L5L 1C6, Canada
| | - Stewart B Harris
- Schulich School of Medicine and Dentistry, Western Centre for Public Health & Family Medicine, Western University, 1465 Richmond St, London, N6G 2M1, ON, Canada
| | - Catherine Birken
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical Sciences Building, 5Th Floor, Room 5271, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Jill Hamilton
- Division of Endocrinology, Hospital for Sick Children, Department of Nutritional Sciences, University of Toronto, 555 University Ave, Toronto, ON, M5S 1X8, Canada
| | - Jonathon L Maguire
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical Sciences Building, 5Th Floor, Room 5271, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Patricia Parkin
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical Sciences Building, 5Th Floor, Room 5271, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Bernard Zinman
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada
| | - Anthony J G Hanley
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical Sciences Building, 5Th Floor, Room 5253A, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
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Yelverton CA, O'Keeffe LM, Bartels HC, McDonnell C, Geraghty AA, O'Brien EC, Killeen SL, Twomey P, Kilbane M, Crowley RK, McKenna M, McAuliffe FM. Association between maternal blood lipids during pregnancy and offspring growth trajectories in a predominantly macrosomic cohort: findings from the ROLO longitudinal birth cohort study. Eur J Pediatr 2023; 182:5625-5635. [PMID: 37819419 DOI: 10.1007/s00431-023-05251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
The purpose of this study is to examine associations between maternal lipid profiles in pregnancy and offspring growth trajectories in a largely macrosomic cohort. This is a secondary analysis of the ROLO birth cohort (n = 293), which took place in the National Maternity Hospital, Dublin, Ireland. Infants were mostly macrosomic, with 55% having a birthweight > 4 kg. Maternal mean age was 32.4 years (SD 3.9 years), mean BMI was 26.1 kg/m2 (SD 4.4 kg/m2) and 48% of children born were males. Total cholesterol, high density lipoprotein cholesterol (HDL-cholesterol), low density lipoprotein cholesterol (LDL-cholesterol) and triglycerides were measured from fasting blood samples of mothers at 14 and 28 week gestation. The change in maternal lipid levels from early to late pregnancy was also examined. Offspring abdominal circumference and weight were measured at 20- and 34-week gestation, birth, 6 months, 2 years and 5 years postnatal. Linear spline multilevel models examined associations between maternal blood lipid profiles and offspring growth. We found some weak, significant associations between maternal blood lipids and trajectories of offspring growth. Significant findings were close to the null, providing limited evidence. For instance, 1 mmol/L increase in maternal triglycerides was associated with faster infant weight growth from 20- to 34-week gestation (0.01 kg/week, 95% CI - 0.02, - 0.001) and slower abdominal circumference from 2 to 5 years (0.01 cm/week, 95% CI - 0.02, - 0.001). These findings do not provide evidence of a clinically meaningful effect. Conclusion: These findings raise questions about the efficacy of interventions targeting maternal blood lipid profiles in pregnancies at risk of macrosomia. New studies on this topic are needed. What is Known: • Maternal fat accumulation during early pregnancy may potentially support fetal growth in the third trimester by providing a reserve of lipids that are broken down and transferred to the infant across the placental barrier. • There are limited studies exploring the impact of maternal lipid profiles on infant and child health using growth trajectories spanning prenatal to postnatal life. What is New: • Maternal blood lipid profiles were not associated with offspring growth trajectories of weight and abdominal circumference during pregnancy up to 5 years of age in a largely macrosomic cohort, as significant findings were close to the null, providing limited evidence for a clinically meaningful relationship. • Strengths of this work include the use of infant growth trajectories that span prenatal to postnatal life and inclusion of analyses of the change of maternal lipid levels from early to late pregnancy and their associations with offspring growth trajectories from 20-week gestation to 5 years of age.
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Affiliation(s)
- C A Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - L M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - H C Bartels
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - C McDonnell
- Department of Paediatric Endocrinology & Diabetes, Children's Health Ireland, Temple Street Hospital, Dublin, Ireland
| | - A A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - E C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Biological, Health and Sports Sciences, Technological University Dublin, Dublin, Ireland
| | - S L Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - P Twomey
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - M Kilbane
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
| | - R K Crowley
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Endocrinology & Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland
| | - M McKenna
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Endocrinology & Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland
| | - F M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Ferreira ALL, Freitas-Costa N, da Silva Rosa Freire S, Figueiredo ACC, Padilha M, Alves-Santos NH, Kac G. Association between persistent organic pollutants in human milk and the infant growth and development throughout the first year postpartum in a cohort from Rio de Janeiro, Brazil. Environ Sci Pollut Res Int 2023; 30:115050-115063. [PMID: 37878172 DOI: 10.1007/s11356-023-30316-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
Persistent organic pollutants (POPs) are compounds that are recalcitrant and ubiquitous that bioaccumulate in human milk (HM) and can impact infant growth and development. We explore the association between POP concentration in HM at 2-50 days postpartum and infant growth and development trajectory throughout the first year of life. A cohort of 68 healthy adult Brazilian women and their infants were followed from 28 to 35 gestational weeks to 12 months postpartum. HM samples were collected between 2 and 50 days postpartum, and POP concentrations were analyzed using gas chromatography with mass spectrometry. Concentrations of POPs >limit of quantification (LOQ) were defined as presence, and concentrations ≤LOQ as an absence. Growth z-scores were analyzed according to WHO growth charts and infant development scores according to Age & Stages Questionnaires at 1 (n = 66), 6 (n = 50), and 12 months (n = 45). Linear mixed effects (LME) models were used to investigate the association of POPs in HM with infant growth and development. Benjamini-Hochberg (BH) correction for multiple testing was performed to reduce the false discovery ratio. P < 0.1 was considered for models with the interaction between POPs and time/sex. After BH correction, adjusted LME models with time interaction showed (1) a positive association between the presence of β hexachlorocyclohexane and an increase in head circumference-for-age z-score (β = 0.003, P = 0.095); (2) negative associations between total POPs (β = -0.000002, P = 0.10), total organochlorine pesticides (β = -0.000002, P = 0.10), and dichlorodiphenyldichloroethylene concentrations in HM (β = -0.000002, P = 0.10) and fine motor scores. No statistical difference between the sexes was observed. Postnatal exposure to organochlorine pesticides in HM shows a positive association with the trajectory of head circumference-for-age z-score and a negative association with the trajectories of fine motor skills scores. Future studies on POP variation in HM at different postpartum times and their effect on infant growth and development should be encouraged.
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Affiliation(s)
- Ana Lorena Lima Ferreira
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Avenida Carlos Chagas Filho 373/CCS, Bloco J, 2o Andar, Sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Nathalia Freitas-Costa
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Avenida Carlos Chagas Filho 373/CCS, Bloco J, 2o Andar, Sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Samary da Silva Rosa Freire
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Avenida Carlos Chagas Filho 373/CCS, Bloco J, 2o Andar, Sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Amanda Caroline Cunha Figueiredo
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Avenida Carlos Chagas Filho 373/CCS, Bloco J, 2o Andar, Sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- Health Science Center, Serra dos Órgãos University Center, Avenida Alberto Tôrres, 111 - Alto, Rio de Janeiro, 25964-004, Teresópilis, Brazil
| | - Marina Padilha
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Avenida Carlos Chagas Filho 373/CCS, Bloco J, 2o Andar, Sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Nadya Helena Alves-Santos
- Faculty of Collective Health, Institute for Health and Biological Studies, Federal University of South and Southeast of Pará, Rodovia BR-230 (Transamazônica), Loteamento Cidade Jardim, Avenida dos Ipês, s/n.o - Cidade Jardim, Maraba, PA, 68500-000, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Avenida Carlos Chagas Filho 373/CCS, Bloco J, 2o Andar, Sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil.
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Chatterjee P, Chen J, Yousafzai A, Kawachi I, Subramanian SV. Area level indirect exposure to extended conflicts and early childhood anthropometric outcomes in India: a repeat cross-sectional analysis. Confl Health 2023; 17:23. [PMID: 37150814 PMCID: PMC10164367 DOI: 10.1186/s13031-023-00519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Protracted, internal conflicts with geographic variations within countries, are an important understudied community exposure for adverse child health outcomes. METHODS Violent events from the Uppsala Conflict Data Program (UCDP) between January 2016-December 2020 and January 2010-December 2015, were included as exposure events for children sampled in National Family Health Surveys (NFHS) 5 (2019-21) and NFHS 4 (2015-16), respectively. Geocoded data from UCDP were merged with residential clusters from NFHS, to identify children living in villages or urban blocks situated at <= 50 km from conflict sites. Within these clusters, which we defined as conflict exposed, we studied risks of stunting, underweight and wasting in children, prenatally, and in 0-3 years. We assessed sensitivity on a subsample of siblings with discordant conflict exposures. RESULTS For NFHS 5, exposure to violence between 0 and 3 years was associated with 1.16 times (95% CI 1.11-1.20) higher risks of stunting, 1.08 (1.04, 1.12) times higher risks of underweight, and no change in wasting. In-utero violence exposure was associated with 1.11 times (95% CI 1.04-1.17) higher risks of stunting, 1.08 (95% CI 1.02-1.14) times higher risks of underweight, and no change in wasting, among children <= 2 years. In 17,760 siblings of 8333 mothers, exposure to violence during 0-3 years, was associated with a 1.19 times higher risk of stunting (95% CI - 0.24 to 0.084). Incremental quartiles of violence exposure had higher risks of stunting and underweight until quartile 3. CONCLUSION In-utero and early childhood indirect exposure to protracted conflicts were associated with increased stunting and underweight in India. Given the continued exposures of such historically and contextually rooted internal conflicts in many LMICs, chronic violence exposures should be targeted in public health policies as important social and political determinant of child health.
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Affiliation(s)
- Pritha Chatterjee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jarvis Chen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA
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8
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Wake SK, Zewotir T, Muluneh EK. Latent growth analysis of children's height growth trajectories. J Dev Orig Health Dis 2023; 14:294-301. [PMID: 36448333 DOI: 10.1017/S2040174422000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Characterizing and quantifying the trajectories of variables of interest through time in their field of study is of interest to a range of disciplines. The aim of this study was to investigate the growth speed in height of children and its determinants. A total of 3401 males and 3200 females from four low- and middle-income countries with measured height on five occasions from 2002 to 2016 were included in the study. Data were analyzed using a latent growth model. The results of the study reported that children in four low- and middle-income countries exhibited substantial growth inequalities. There was a significant gender difference in change of growth with males had a higher baseline, rate of change, and acceleration in height growth than females. Comparing the component of slopes across countries, the growth change inequalities were observed among children. These inequalities were statistically significant, with the highest rate of change observed in Peru and Vietnam.
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9
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Abstract
The World Health Organization (WHO) growth standards provide the most recognized and widely accepted way of assessing child growth. To ensure its applicability, accuracy, and reliability, studies have validated WHO growth standards against local populations and other internationally recognized growth references. We reviewed outcomes of evaluations done on WHO growth standards and assess the appropriateness of using these growth standards on a global level. We undertook a systematic quantitative review of studies published from 2011 to 2020 from multiple databases. Studies were included if they considered children aged 59 months and below and reported on validation of growth standards. There was an agreement in studies that validated WHO growth standards against international growth references of its superiority in identifying stunted, overweight, and obese children. However, they were less likely to identify underweight children. None of the studies reviewed reported similar growth trajectories to WHO standards in all indicators considered. Regional differences in child growth were observed in comparison to WHO growth standards. Adoption of regional-specific standards increases the sensitivity of identifying children with adverse nutrition outcomes.
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Affiliation(s)
- Anesu Marume
- 72753College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Ministry of Health and Child Care, Harare, Zimbabwe
| | - Moherndran Archary
- 72753College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,164785King Edward VIII Hospital, Durban, South Africa
| | - Saajida Mahomed
- 72753College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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10
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Lourenção LFDP, de Paula NC, Cardoso MA, Santos PR, de Oliveira IRC, Fonseca FLA, da Veiga GL, Alves BDCA, Graciano MMDC, Pereira-Dourado SM. Biochemical markers and anthropometric profile of children enrolled in public daycare centers. J Pediatr (Rio J) 2022; 98:390-398. [PMID: 34774468 PMCID: PMC9432236 DOI: 10.1016/j.jped.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The nutritional status resultant from dietary habits along with socioeconomic conditions and the school environment are directly related to the individual's health condition not only in their childhood but also throughout adulthood. The aim of this study was to evaluate the effects of socioeconomic factors on the anthropometric profile and to analyze a probable association between this profile and biochemical markers in children attending public daycare centers. METHODS It is a transversal study developed in a probability sample of clusters of children from 6 months to 5 years old. Anthropometric and socioeconomic data were gathered at the CMEIs, questionnaires on the nutritional status were applied and blood was collected at the Family Health Units (USFs). RESULTS Female children are three times more likely to be underweight; in families with five members, it is 1/3 more likely that children of higher-educated parents are overweight. Among the results of the biochemical tests, hypervitaminosis A was a relevant aspect, positively correlating with copper (p=0.005) and zinc (p=0.008). CONCLUSION Therefore, since the influence of the family is an important predictor of overweight and its future outcomes related to nutritional deficiencies and inadequate dietary intake, educational interventions are vital as a way to pave the path to prevention.
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Affiliation(s)
| | | | | | | | | | - Fernando Luiz Affonso Fonseca
- Universidade Federal de São Paulo (UNIFESP), Departamento de Ciências Farmacêuticas, Diadema, SP, Brazil; Centro Universitário Saúde ABC, Laboratório de Análises Clínicas, Santo André, SP, Brazil.
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11
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Yadav S, Bhandari P. Age heterogeneities in child growth and its associated socio-demographic factors: a cross-sectional study in India. BMC Pediatr 2022; 22:384. [PMID: 35773654 PMCID: PMC9248138 DOI: 10.1186/s12887-022-03415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background The impacts of socio-demographic and environmental risk factors on child growth have been widely documented. However, it remains unclear whether the impacts of such risk factors on child growth have remained static or changed with child’s age. The present study aims to assess the underlying age heterogeneities in child growth and its potential determinants over age in under-five children. Methods Cross-sectional data on child height (measured as height-for-age z-score, i.e., HAZ) and weight (measured as weight-for-age z-score, i.e., WAZ) and potential confounding factors from India’s 2015–16 National Family Health Survey (NFHS) were used to construct anthropometric age-profiles by a number of bio-demographic and socioeconomic characteristics. Further, age-interacted multilevel regression analyses were performed to examine differential effects of such/those risk factors on child height and weight by age. Results Faltered height and weight growth during first two years of life was noticed in children of all socioeconomic groups studied, albeit with varying magnitude. In case of child’s height, factors such as short birth interval, higher birth order, maternal education, household wealth, district level mortality rate have shown strong interaction with child’s age during the first 23 months, signifying their age-varying role in different developmental stages of child growth. These factors explain the observed upward and downward shifts in height curve during first two years. Some of these variables (e.g., household wealth) have shown even stronger age interactions after the second birthday of children. For child’s weight, interactive effects of most socio-demographic risk factors attenuated parabolically with child’s age. Conclusions The impacts of several risk factors, measured at the child, mother, community, and district levels, on child growth indicators varied significantly with the child’s age. Nutritional interventions aimed at preventing poor linear growth in children in India should consider these underlying age heterogeneities for growth determinants into account. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03415-x.
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Affiliation(s)
- Suryakant Yadav
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, 400088, India
| | - Pravat Bhandari
- International Institute for Population Sciences, Mumbai, 400088, India.
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12
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Karuppusami R, Antonisamy B, Premkumar PS. Functional principal component analysis for identifying the child growth pattern using longitudinal birth cohort data. BMC Med Res Methodol 2022; 22:76. [PMID: 35313828 PMCID: PMC8935724 DOI: 10.1186/s12874-022-01566-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Longitudinal studies are important to understand patterns of growth in children and limited in India. It is important to identify an approach for characterising growth trajectories to distinguish between children who have healthy growth and those growth is poor. Many statistical approaches are available to assess the longitudinal growth data and which are difficult to recognize the pattern. In this research study, we employed functional principal component analysis (FPCA) as a statistical method to find the pattern of growth data. The purpose of this study is to describe the longitudinal child growth trajectory pattern under 3 years of age using functional principal component method. Methods Children born between March 2002 and August 2003 (n = 290) were followed until their third birthday in three neighbouring slums in Vellore, South India. Field workers visited homes to collect details of morbidity twice a week. Height and weight were measured monthly from 1 month of age in a study-run clinic. Longitudinal child growth trajectory pattern were extracted using Functional Principal Component analysis using B-spline basis functions with smoothing parameters. Functional linear model was used to assess the factors association with the growth functions. Results We have obtained four FPCs explained by 86.5, 3.9, 3.1 and 2.2% of the variation respectively for the height functions. For height, 38% of the children’s had poor growth trajectories. Similarly, three FPCs explained 76.2, 8.8, and 4.7% respectively for the weight functions and 44% of the children’s had poor growth in their weight trajectories. Results show that gender, socio-economic status, parent’s education, breast feeding, and gravida are associated and, influence the growth pattern in children. Conclusions The FPC approach deals with subjects’ dynamics of growth and not with specific values at given times. FPC could be a better alternate approach for both dimension reduction and pattern detection. FPC may be used to offer greater insight for classification. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01566-0.
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Affiliation(s)
- Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632002, India
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13
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Vaivada T, Ahsan H, Zaman M, Miller SP, Bhutta ZA. 1.4.7 Nutrition, Brain Development, and Mental Health. World Rev Nutr Diet 2022; 124:122-132. [PMID: 35240651 DOI: 10.1159/000517388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Hanaa Ahsan
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Michele Zaman
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Steven P Miller
- Department of Paediatrics, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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14
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Schwinger C, Kvestad I, Chandyo RK, Ulak M, Shrestha M, Ranjitkar S, Strand TA. The association between biomass fuel use for cooking and linear growth in young children in Bhaktapur, Nepal. Environ Int 2022; 161:107089. [PMID: 35063791 DOI: 10.1016/j.envint.2022.107089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There are still many people in the world who prepare their meals on open fires or stoves using solid fuels from biomass, especially in low-and middle-income countries. Although biomass cooking fuels have been associated with adverse health impacts and diseases, the association with child linear growth remains unclear. OBJECTIVES In a cohort design, we aimed to describe the association between the use of biomass cooking fuels and linear growth in children aged 18-23 months living in the urban and peri-urban community of Bhaktapur, situated in the Kathmandu valley in Nepal. METHODS Caretakers of 600 marginally stunted children aged 6-11 months were interviewed about their source of cooking fuel and other socio-demographic characteristics at enrolment into a randomized controlled trial. Children's body length was measured when children were 18-23 months old. In linear regression models, we estimated the association between the use of biomass fuel and length-for-age Z-scores (LAZ), adjusted for relevant confounders. We repeated these analyses in pre-defined sub-groups and different percentiles of LAZ using quantile regression models. RESULTS Among study participants, 101 (18%) used biomass as cooking fuel. The association between biomass fuel and LAZ was not statistically significant in the full sample (adjusted regression coefficient: -0.14, 95% CI: -0.28, 0.00). The association was stronger in some of the sub-groups and in the lower tail of the LAZ distribution (those who are stunted), but neither reached statistical significance. DISCUSSION Children from households in poor, urban neighborhoods in Nepal which used biomass fuel for cooking were on average slightly shorter than other children, although the association only approached statistical significance. As this was an observational study, residual confounding cannot be excluded. Further studies are needed to confirm these associations, in particular those seen in certain sub-groups.
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Affiliation(s)
- Catherine Schwinger
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ram K Chandyo
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Manjeswori Ulak
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Merina Shrestha
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Suman Ranjitkar
- Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Tor A Strand
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway.
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15
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De Silva Perera U, Inder BA. Midday meals as an early childhood nutrition intervention: evidence from plantation communities in Sri Lanka. BMC Public Health 2021; 21:2224. [PMID: 34876076 PMCID: PMC8650296 DOI: 10.1186/s12889-021-11843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND High rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of 5 years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children. METHODS The study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data was collected on heights and weights of children, between 2013 and 2015. Standardized weight-for-age, height-for-age and weight-for-height, and binary variables for stunting, wasting and underweight are constructed, following WHO guidelines. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth while random-effects logistic regression is used for the binary outcomes. Robustness analysis involves different estimation methods and subsamples. RESULTS The dataset comprises of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model specifications and across different subsamples by gender, birthweight and birth-year cohort. CONCLUSIONS Midday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.
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Affiliation(s)
- Udeni De Silva Perera
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Brett A. Inder
- Research Fellow, Centre for Health Economics, Monash University, 900, Dandenong Road, Caulfield campus, Melbourne, VIC 3145 Australia
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16
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Terho AM, Pelkonen S, Toikkanen R, Koivurova S, Salo J, Nuojua-Huttunen S, Pokka T, Gissler M, Tiitinen A, Martikainen H. Childhood growth of term singletons born after frozen compared with fresh embryo transfer. Reprod Biomed Online 2021; 43:719-726. [PMID: 34493461 DOI: 10.1016/j.rbmo.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/17/2022]
Abstract
RESEARCH QUESTION Is the growth of term singletons born after frozen embryo transfer (FET) comparable to those born after fresh embryo transfer and natural conception up to 5 years of age? DESIGN Observational cohort study in an academic medical centre and municipal child health clinics with repeated measurements carried out by medical professionals. Term singletons born after FET (n = 110) and fresh embryo transfer (n = 181) and their matched natural conception controls (n = 543) born in Oulu, Northern Finland, were included. Mean weights, lengths, heights and head circumferences at the ages of 4, 8 and 18 months and 3 and 5 years were compared. At 3 and 5 years, body mass indices were compared. RESULTS Childhood growth did not differ between term singletons born after FET, fresh embryo transfer and natural conception, correcting for exact age at measurement and adjusting for maternal body mass index and paternal height. CONCLUSIONS Similar growth between children born after FET, fresh embryo transfer and natural conception offers reassurance of the safety and feasibility of the steadily increasing use of embryo cryopreservation in assisted reproduction.
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Affiliation(s)
- Anna Maria Terho
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland; Medical Research Center, PEDEGO Research Unit, University of Oulu, Oulu, Finland.
| | - Sari Pelkonen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland; Medical Research Center, PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Ronja Toikkanen
- Faculty of Medicine, University of Oulu, PL 5000, Oulun Yliopisto Oulu 90014, Finland
| | - Sari Koivurova
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland
| | - Jarmo Salo
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland
| | | | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, PL 30, Helsinki 00271, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet and Region Stockholm, Academic Primary Health Care Centre Stockholm, Sweden
| | - Aila Tiitinen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, University of Helsinki, PL 140, Helsinki HUS 00029, Finland
| | - Hannu Martikainen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, PL 23, Oulu 90029 OYS, Finland; Medical Research Center, PEDEGO Research Unit, University of Oulu, Oulu, Finland
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17
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Ong J, Sadananthan SA, Soh SE, Ng S, Yuan WL, Aris IM, Tint MT, Michael N, Loy SL, Tan KH, Godfrey KM, Shek LP, Yap F, Lee YS, Chong YS, Chan SY. Increasing nausea and vomiting of pregnancy is associated with sex-dependent differences in early childhood growth: the GUSTO mother-offspring cohort study. BMC Pregnancy Childbirth 2021; 21:578. [PMID: 34420517 PMCID: PMC8380383 DOI: 10.1186/s12884-021-04024-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) is common and underlying mechanisms are poorly understood. Longer-term offspring outcomes are also not well documented. This study aimed to determine if NVP, even in milder forms, is associated with adverse pregnancy and childhood growth outcomes. METHODS In the GUSTO prospective mother-offspring cohort, women with singleton pregnancies (n = 1172) recruited in first trimester responded to interviewer-administered questions at 26-28 weeks' gestation about earlier episodes of NVP since becoming pregnant. Pregnancy outcomes were obtained from medical records. Offspring height and weight measured at 15 time-points between birth to 72 months (m) were standardised for age and sex. RESULTS 58.5% (n = 686) reported mild-moderate vomiting (mNVP), 10.5% (n = 123) severe vomiting (sNVP) and 5.7% (n = 67) severe vomiting with hospitalisation (shNVP). There was no difference in odds of gestational diabetes, hypertensive disorders of pregnancy, labour induction or caesarean section after adjustment for covariates. sNVP was associated with late preterm delivery [34+ 0-36+ 6 weeks', adjusted OR = 3.04 (95% CI 1.39,6.68)], without increased odds of neonatal unit admission. Compared with no NVP, boys born to mothers with sNVP were longer at birth [adjusted β = 0.38 standard deviations (SDs) (95% CI 0.02,0.73)], remained taller [0.64 SDs (0.23,1.04) at 72 m] and heavier [0.57 SDs (0.05,1.08) at 60 m] without differences in BMI. Conversely, girls born to mothers with shNVP were lighter from 48 m [- 0.52 SDs (- 1.00, - 0.03)] onwards with lower BMI [- 0.61 SDs (- 1.12,-0.09)]. Conditional growth modelling revealed significant sex-divergence in weight-gain at birth-3 m, 6-9 m and 4-5 years. CONCLUSIONS Severe NVP was associated with late preterm delivery, and both mild-moderate and severe NVP associated with sex-dependent differences in early childhood growth. Boys whose mothers had NVP were taller and heavier from birth with faster growth in the first year, whereas, girls had poorer weight gain and were lighter by 48 m. As even milder severities of NVP could have long-term impact on offspring growth, further research is needed to determine mechanisms involved and implications on future health. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01174875 .
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Affiliation(s)
- Judith Ong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
| | | | - Shu-E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sharon Ng
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
| | - Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Izzuddin M Aris
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | - Mya Thway Tint
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - See Ling Loy
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lynette P Shek
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore.
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore.
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Massara P, Keown-Stoneman CD, Erdman L, Ohuma EO, Bourdon C, Maguire JL, Comelli EM, Birken C, Bandsma RH. Identifying longitudinal-growth patterns from infancy to childhood: a study comparing multiple clustering techniques. Int J Epidemiol 2021; 50:1000-1010. [PMID: 33693803 DOI: 10.1093/ije/dyab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most studies on children evaluate longitudinal growth as an important health indicator. Different methods have been used to detect growth patterns across childhood, but with no comparison between them to evaluate result consistency. We explored the variation in growth patterns as detected by different clustering and latent class modelling techniques. Moreover, we investigated how the characteristics/features (e.g. slope, tempo, velocity) of longitudinal growth influence pattern detection. METHODS We studied 1134 children from The Applied Research Group for Kids cohort with longitudinal-growth measurements [height, weight, body mass index (BMI)] available from birth until 12 years of age. Growth patterns were identified by latent class mixed models (LCMM) and time-series clustering (TSC) using various algorithms and distance measures. Time-invariant features were extracted from all growth measures. A random forest classifier was used to predict the identified growth patterns for each growth measure using the extracted features. RESULTS Overall, 72 TSC configurations were tested. For BMI, we identified three growth patterns by both TSC and LCMM. The clustering agreement was 58% between LCMM and TS clusters, whereas it varied between 30.8% and 93.3% within the TSC configurations. The extracted features (n = 67) predicted the identified patterns for each growth measure with accuracy of 82%-89%. Specific feature categories were identified as the most important predictors for patterns of all tested growth measures. CONCLUSION Growth-pattern detection is affected by the method employed. This can impact on comparisons across different populations or associations between growth patterns and health outcomes. Growth features can be reliably used as predictors of growth patterns.
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Affiliation(s)
- Paraskevi Massara
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Charles Dg Keown-Stoneman
- Applied Health Research Center, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lauren Erdman
- Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada.,Department of Computer Science, School of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Eric O Ohuma
- Center for Global Child Health & Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elena M Comelli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Joannah and Brian Lawson Center for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Catherine Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Hj Bandsma
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada
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Tayie FA, Lambert LA, Aryeetey R, Xu B, Brewer G. Anthropometric characteristics of children living in food-insecure households in the USA. Public Health Nutr 2021;:1-9. [PMID: 34047265 DOI: 10.1017/S1368980021002378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study provides information on food insecurity and child malnutrition in a technologically advanced nation. DESIGN Population-based study using multistage probability cluster sampling design to collect survey data. Multivariable regression models were used to determine associations between food security status and various malnutrition indices. SETTING We used a national sample from the US National Health and Nutrition Examination Survey 2011-2014. PARTICIPANTS The anthropometric and demographic data sets of 4121 children <7 years old were analysed for this study. RESULTS Food-insecure infants younger than 6 months had shorter upper arm length (-0·4 cm, P = 0·012) and smaller mid-upper arm circumference (-0·5 cm, P = 0·004); likewise those aged 6 months-1 year had shorter upper arm length (-0·4 cm, P = 0·008), body length (-1·7 cm, P = 0·007) and lower body weight (-0·5 kg, P = 0·008). Food-insecure children younger than 2 years were more likely to be underweight (OR: 4·34; 95 % CI 1·99, 9·46) compared with their food-secure counterparts. Contrariwise, food-insecure children older than 5 years were more likely to be obese (OR: 3·12; 95 % CI 1·23, 7·96). CONCLUSIONS Food insecurity associates with child growth deficits in the USA. Food-insecure infants and young children are generally smaller and shorter, whereas older children are heavier than their food-secure counterparts, implying a double burden of undernutrition-overnutrition associated with child food insecurity. Child food and nutrition programmes to improve food insecurity should focus on infants and children in the transition ages.
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20
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Wu T, Shi H, Niu J, Yin X, Wang X, Shen Y. Distance to water source in early childhood affects growth: a cohort study. Public Health 2021; 193:139-145. [PMID: 33838573 DOI: 10.1016/j.puhe.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Approximately 165 million children aged <5 years are at risk of low height-for-age. This study explored whether water quality and distance to water source affected short- and long-term growth, and the critical time windows of such effects. STUDY DESIGN This study used data from the China Health and Nutrition Survey (CHNS), which was a cohort study performed in 15 Chinese provinces. METHODS Data from the CHNS between 1989 and 2011 were examined. Three cohorts of children who were enrolled at 0-2 years of age in 1989, 1993, and 2000 provided sufficient data for this study. Child height was measured by physicians, and household water supply, including the water quality (safe or unsafe) and distance to the source (in-yard or out-yard), was assessed using a questionnaire when the children were 0-2, 4-6, and 11-13 years of age. Multiple regressions were performed to analyse the associations between water quality and distance to the source at various ages, and height at that age and older ages, with and without adjusting for the household water supply at previous ages. Multiple informant models were created using a generalised estimating equation and these were used to assess whether the exposure coefficients were equal across the three age periods. RESULTS A total of 1192 children were included. Water quality was not significantly associated with height over the three age periods. An out-yard water source at the age of 0-2 years was not associated with child height at that age, but it was inversely associated with child height at ages 4-6 and 11-13 years (β = -1.605, 95% confidence interval [CI]: -2.490 to -0.720, and β = -2.817, 95% CI: -4.411 to -1.224, respectively), after adjusting for sociodemographic and economic covariates and baseline child height. Distance to the water source at age 4-6 and 11-13 years was not significantly associated with height. However, significant differences were observed in the associations between distance to water source across the three age periods and height at age 4-6 and 11-13 years (pint = 0.064 and 0.069, respectively). CONCLUSIONS Distance to the water source in early, but not later, childhood exerted a long-term effect on child height. When the water quality is good, efforts should be made to shorten the distance to the source to improve child health and growth.
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Affiliation(s)
- T Wu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - H Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - J Niu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - X Yin
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - X Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China; National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
| | - Y Shen
- School of Economics and Resource Management, Beijing Normal University, Beijing, China.
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21
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Sié A, Coulibaly B, Dah C, Bountogo M, Ouattara M, Compaoré G, Brogdon JM, Godwin WW, Lebas E, Doan T, Arnold BF, Porco TC, Lietman TM, Oldenburg CE. Single-dose azithromycin for child growth in Burkina Faso: a randomized controlled trial. BMC Pediatr 2021; 21:130. [PMID: 33731058 DOI: 10.1186/s12887-021-02601-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background In lower resource settings, previous randomized controlled trials have demonstrated evidence of increased weight gain following antibiotic administration in children with acute illness. We conducted an individually randomized trial to assess whether single dose azithromycin treatment causes weight gain in a general population sample of children in Burkina Faso. Methods Children aged 8 days to 59 months were enrolled in November 2019 and followed through June 2020 in Nouna Town, Burkina Faso. Participants were randomly assigned to a single oral dose of azithromycin (20 mg/kg) or matching placebo. Anthropometric measurements were collected at baseline and 14 days and 6 months after enrollment. The primary anthropometric outcome was weight gain velocity in g/kg/day from baseline to 14 days and 6 months in separate linear regression models. Results Of 450 enrolled children, 230 were randomly assigned to azithromycin and 220 to placebo. Median age was 26 months (IQR 16 to 38 months) and 51% were female. At 14 days, children in the azithromycin arm gained a mean difference of 0.9 g/kg/day (95% CI 0.2 to 1.6 g/kg/day, P = 0.01) more than children in the placebo arm. There was no difference in weight gain velocity in children receiving azithromycin compared to placebo at 6 months (mean difference 0.04 g/kg/day, 95% CI − 0.05 to 0.13 g/kg/day, P = 0.46). There were no significant differences in other anthropometric outcomes. Conclusions Transient increases in weight gain were observed after oral azithromycin treatment, which may provide short-term benefits. Clinical trials registration ClinicalTrials.gov NCT03676751. Registered 19/09/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02601-7.
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Hanieh S, Mahanty S, Gurruwiwi G, Kearns T, Dhurrkay R, Gondarra V, Shield J, Ryan N, Azzato F, Ballard SA, Orlando N, Nicholson S, Gibney K, Brimblecombe J, Page W, Harrison LC, Biggs BA. Enteric pathogen infection and consequences for child growth in young Aboriginal Australian children: a cross-sectional study. BMC Infect Dis 2021; 21:9. [PMID: 33407180 PMCID: PMC7788727 DOI: 10.1186/s12879-020-05685-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To determine the prevalence of enteric infections in Aboriginal children aged 0-2 years using conventional and molecular diagnostic techniques and to explore associations between the presence of pathogens and child growth. METHODS Cross-sectional analysis of Aboriginal children (n = 62) residing in a remote community in Northern Australia, conducted from July 24th - October 30th 2017. Stool samples were analysed for organisms by microscopy (directly in the field and following fixation and storage in sodium-acetate formalin), and by qualitative PCR for viruses, bacteria and parasites and serology for Strongyloides-specific IgG. Child growth (height and weight) was measured and z scores calculated according to WHO growth standards. RESULTS Nearly 60% of children had evidence for at least one enteric pathogen in their stool (37/62). The highest burden of infection was with adenovirus/sapovirus (22.9%), followed by astrovirus (9.8%) and Cryptosporidium hominis/parvum (8.2%). Non-pathogenic organisms were detected in 22.5% of children. Ten percent of children had diarrhea at the time of stool collection. Infection with two or more pathogens was negatively associated with height for age z scores (- 1.34, 95% CI - 2.61 to - 0.07), as was carriage of the non-pathogen Blastocystis hominis (- 2.05, 95% CI - 3.55 to - 0.54). CONCLUSIONS Infants and toddlers living in this remote Northern Australian Aboriginal community had a high burden of enteric pathogens and non-pathogens. The association between carriage of pathogens/non-pathogens with impaired child growth in the critical first 1000 days of life has implications for healthy child growth and development and warrants further investigation. These findings have relevance for many other First Nations Communities that face many of the same challenges with regard to poverty, infections, and malnutrition.
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Affiliation(s)
- Sarah Hanieh
- Department of Medicine at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.
| | - Siddhartha Mahanty
- Department of Medicine at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,The Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, 3052, Australia
| | - George Gurruwiwi
- Menzies School of Health Research, Darwin, Northern Territory, 0810, Australia
| | - Therese Kearns
- Menzies School of Health Research, Darwin, Northern Territory, 0810, Australia
| | - Roslyn Dhurrkay
- Menzies School of Health Research, Darwin, Northern Territory, 0810, Australia
| | - Veronica Gondarra
- Menzies School of Health Research, Darwin, Northern Territory, 0810, Australia
| | - Jenny Shield
- Department of Medicine at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Norbert Ryan
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Susan A Ballard
- Microbiological Diagnostic Unit Public Health Laboratory at the University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Nicole Orlando
- Microbiological Diagnostic Unit Public Health Laboratory at the University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sullen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Katherine Gibney
- The Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, 3052, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Wendy Page
- Miwatj Health Aboriginal Corporation, Nhulunbuy, NT, 0881, Australia.,Public Health and Tropical Medicine, James Cook University, Cairns, QLD, 4870, Australia
| | - Leonard C Harrison
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Beverley-Ann Biggs
- The Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, 3052, Australia
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23
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Finaret AB, Masters WA. Can shorter mothers have taller children? Nutritional mobility, health equity and the intergenerational transmission of relative height. Econ Hum Biol 2020; 39:100928. [PMID: 33068874 DOI: 10.1016/j.ehb.2020.100928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
This study develops the concept of nutritional mobility, defined here as the probability that a mother ranked low in her cohort's height distribution will have a child who attains a higher rank order. We demonstrate that rank-order regression provides a robust metric of health equity, revealing differences in opportunities for each child to reach their own growth potential. We estimate four indicators of nutritional mobility and test for associations between nutritional mobility and various local economic and environmental factors. Nutritional mobility has improved over time, and the nutrition environment contributes about 2.86 times as much as a mother's height to her child's expected rank in height-for-age. Populations with the least mobility are in Latin America, and the most mobility is in more urbanized areas of Africa and Asia. Rank-order mobility is an important aspect of health equity, offering valuable insight into the role of socioecological factors in nutrition improvement across generations.
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Affiliation(s)
- Amelia B Finaret
- Department of Global Health Studies, Allegheny College, 520 N. Main Street, Meadville, PA, 16335, United States.
| | - William A Masters
- Friedman School of Nutrition Science and Policy and Department of Economics, Tufts University, United States
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Loli S, Carcamo CP. Rotavirus vaccination and stunting: Secondary Data Analysis from the Peruvian Demographic and Health Survey. Vaccine 2020; 38:8010-5. [PMID: 33139135 DOI: 10.1016/j.vaccine.2020.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/11/2020] [Accepted: 10/12/2020] [Indexed: 01/04/2023]
Abstract
Rotavirus infection is the leading cause of acute diarrhea in children and is preventable with a vaccine. Malnutrition increases the risk for the development of enteric and respiratory diseases, but also diarrhea increases the risk for stunting, having a negative effect in height-for-age Z score (HAZ). Therefore, Rotavirus can be considered as one of the contributing factors to stunting. The objective was to determine if vaccination against rotavirus was associated with changes in HAZ of children aged 6-60 months. We analyzed the data of Demographic and Health Survey (DHS) 2015-2017 for Peru, which is a nationwide representative. We fitted linear regression models controlling for complex sampling. The vaccine coverage was close to 75.5%, and the mean HAZ was -0.76 standard deviations. After adjusting by demographic, health, and household characteristics, children who received rotavirus vaccine, had a mean HAZ 0.06 standard deviations higher than children who did not receive it. Additionally, BCG vaccination, a higher education level of the mother, a higher wealth index, and treating water for drinking were positively associated with HAZ. On the other hand, we found low birth weight, lack of flush toilet, and altitude higher than 2500 m above sea level negatively associated with HAZ. Rotavirus vaccine is associated with better anthropometric measurements.
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25
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Zanardi DM, Santos JP, Pacagnella RC, Parpinelli MA, Silveira C, Andreucci CB, Ferreira EC, Angelini CR, Souza RT, Costa ML, Cecatti JG. Long-Term Consequences of Severe Maternal Morbidity on Infant Growth and Development. Matern Child Health J 2020; 25:487-496. [PMID: 33196923 DOI: 10.1007/s10995-020-03070-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Severe maternal morbidity (SMM) is already known to be associated with adverse neonatal outcomes, however, its association with long-term deficits of weight and height, and impairment in neurodevelopment among children was not yet fully assessed. We aim to evaluate whether SMM has repercussions on the weight and height-for-age and neurodevelopmental status of the child. METHODS A retrospective cohort analysis with women who had SMM events in a tertiary referral center in Brazil. They were compared to a control group of women who had not experienced any SMM. Childbirth and perinatal characteristics, weight and height-for-age deficits and neurodevelopmental impairment suspicion by Denver II Test were comparatively assessed in both groups using RR and 95% CI. Multiple regression analysis was used addressing deficit of weight-for-age, height-for-age and an altered Denver Test, estimating their independent adjusted RR and 95% CI. RESULTS 634 women with perinatal outcomes available (311 with SMM and 323 without) and 571 children were assessed. Among women with SMM, increased rates in perinatal deaths, Apgar lower than 7 at five minutes, shorter breastfeeding period, preterm birth (49.0% × 11.1%), low birthweight (45.8% × 11.5%), deficits of weight-for-age [RR 3.11 (1.60-6.04)] and height-for-age [RR 1.52 (1.06-2.19)] and altered Denver Test [RR 1.5 (1.02-2.36)] were more frequently found than in the control group. SMM was not identified as independently associated with any of the main outcomes. CONCLUSION SMM showed to be associated with a negative impact on growth and neurodevelopment aspects of perinatal and infant health. These findings suggest that effective health policies directed towards appropriate care of pregnancy may have an impact on the reduction of maternal, neonatal and infant morbidity and mortality.
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Affiliation(s)
- Dulce M Zanardi
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Juliana P Santos
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Mary A Parpinelli
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Carla B Andreucci
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
- Department of Medicine, School of Medicine, Federal University of Sao Carlos, São Carlos, Brazil
| | - Elton C Ferreira
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Carina R Angelini
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Maria L Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, CAISM, University of Campinas, Campinas, Brazil.
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Mank I, Vandormael A, Traoré I, Ouédraogo WA, Sauerborn R, Danquah I. Dietary habits associated with growth development of children aged < 5 years in the Nouna Health and Demographic Surveillance System, Burkina Faso. Nutr J 2020; 19:81. [PMID: 32772913 PMCID: PMC7416397 DOI: 10.1186/s12937-020-00591-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
Background Knowing which dietary habits are associated with child growth could lead to better long-term health outcomes and improve the design of food-based interventions. We aimed to identify dietary habits that are associated with the growth development of children aged < 5 years living in rural Burkina Faso. Methods This study used cross-sectional baseline data from 514 children (8–59 months) within the Nouna Health and Demographic Surveillance System (HDSS) in 2018. Household socio-demographics and child dietary habits, height and weight were assessed. We constructed scores for dietary diversity (DDS) and food variety (FVS), and extracted exploratory dietary pattern scores (DPS) using principal component analysis (PCA). Child growth was measured using height-for-age (HAZ) and weight-for-height z-scores (WHZ). We used multiple-adjusted linear regressions considering for socio-economic factors to quantify associations. Results In this study population (median 36 ± 14 months old), stunting (HAZ < − 2) was seen in 26% and wasting (WHZ < − 2) in 7%. The DDS (median 7 ± 2 food groups) was positively associated with WHZ, while the FVS (median 13 ± 8 food items) was inversely associated with HAZ. We identified 4 dietary patterns: leaves-based, beans and poultry-based, maize and fish-based, and millet and meat-based diets. Only the maize and fish-based diet showed a statistically significant and here positive trend for associations with WHZ. Conclusion Growth development of children aged < 5 years continues to be a health problem in the Nouna HDSS. A higher dietary diversity and food variety and dietary patterns characterized by maize and fish and beans and poultry intake appear to be beneficial for growth of young children in this area.
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Affiliation(s)
- Isabel Mank
- Heidelberg Institute of Global Health (HIGH), Medical Faculty, Heidelberg University, Heidelberg, Germany.
| | - Alain Vandormael
- Heidelberg Institute of Global Health (HIGH), Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Issouf Traoré
- Centre de Recherche en Santé de Nouna (CRSN), Institut National de Santé Publique (INSP), Nouna, Burkina Faso.,Institut Universitaire de Formations Initiale et Continue (IUFIC), Université Ouaga II (UO2), Ouagadougou, Burkina Faso
| | | | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Medical Faculty, Heidelberg University, Heidelberg, Germany
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27
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Ispas-Jouron S, Seuc A, Northstone K, Festin M. Effects of maternal use of hormonal contraception during breastfeeding: Results from a British birth cohort. Eur J Obstet Gynecol Reprod Biol 2020; 250:143-149. [PMID: 32442839 DOI: 10.1016/j.ejogrb.2020.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The impact of early hormonal contraception (HC) exposure during breastfeeding on child growth and pubertal and behavioural development was assessed using data from the Avon Longitudinal Study of Parents and Children (Avon study). STUDY DESIGN The Avon study is a prospective cohort study designed to identify environmental factors affecting child health and development (n = 14,541; delivery dates: 1 April 1991-31 December 1992). This secondary analysis was restricted to breastfed singleton infants. The main independent predictor variable was HC exposure during the first 8 weeks postpartum. Growth variables were changes from baseline in weight and height at ages 2 and 4 years. Behavioural variables were assessed at age 47 months. Pubertal development was evaluated between ages 8- and 16-years using Tanner scales. RESULTS 9508 children were breastfed during the first 4 weeks postpartum; 8927 had complete data for breastfeeding and HC exposure. Multivariate analyses demonstrated no difference in growth outcome variables between breastfed infants exposed to HC and those who were not. Similarly, no differences in behavioural problems or pubertal development were observed between the two groups. CONCLUSIONS Early HC exposure during breastfeeding did not appear to influence negatively child growth and development. Limitations include short-term exposure to HC, the discrepancy between the timepoints when HC intake and breastfeeding were measured and the missing data, particularly regarding growth measurements Further clinical studies are required to confirm this lack of negative impact. IMPLICATIONS STATEMENT Guidance on the use of HC during breastfeeding remains controversial; however, the Avon study did not detect any signal to suggest that early exposure to HC via breastfeeding has a negative impact on child growth, development or behaviour.
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Affiliation(s)
- Simona Ispas-Jouron
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland.
| | - Armando Seuc
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland.
| | - Kate Northstone
- Bristol Medical School, University of Bristol, Bristol BS8 2BN, United Kingdom.
| | - Mario Festin
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland.
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Martin S, Mutuku F, Sessions J, Lee J, Mukoko D, Malhotra I, King CH, LaBeaud AD. Factors associated with early childhood stunted growth in a 2012-2015 birth cohort monitored in the rural Msambweni area of coastal Kenya: a cross-sectional study. BMC Pediatr 2020; 20:208. [PMID: 32398049 PMCID: PMC7216696 DOI: 10.1186/s12887-020-02110-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic malnutrition, often measured as stunted growth, is an understudied global health problem. Though poor nutritional intake has been linked to stunted growth, there is evidence suggesting environmental exposures may have a significant role in its occurrence. Here, we characterize the non-nutritional prenatal and postnatal factors that contribute to early childhood stunted growth in rural coastal Kenya. METHODS Overall, 232 women and 244 children from a 2012-2015 maternal-child cohort in Msambweni, Kenya were included. Women were tested for parasitic infections during the prenatal period and at the time of delivery. Children were tested for parasitic infections and assessed for stunted growth using height-for-age Z-scores (HAZ) at 6-month intervals after birth. Socioeconomic status (SES) was evaluated using both a simplified water, asset, maternal education, and income (WAMI) index and a principal component analysis (PCA) asset score. Multivariate logistic regression analysis was used to determine the relative influence of prenatal and postnatal factors on the occurrence of stunted growth. RESULTS Of the 244 children (ages 6-37 months), 60 (25%) were stunted at the study endpoint. 179 mothers (77%) had at least one parasitic infection during pregnancy and 94 children (38%) had at least one parasitic infection during the study period. There was no significant association between maternal parasitic infection and child stunted growth (p = 1.00). SES as determined using the WAMI index was not associated with HAZ in linear regression analysis (p = 0.307), however, the PCA asset score was (p = 0.048). Multivariate logistic regression analysis identified low birth weight (AOR: 3.24, 95% CI: [1.38, 7.57]) and child parasitic infectious disease burden (AOR: 1.41, 95% CI: [1.05, 1.95]) as independent predictors of stunted growth, though no significant association was identified with PCA asset score (AOR: 0.98, 95% CI: [0.88, 1.10]). CONCLUSIONS Stunted growth remains highly prevalent in rural Kenya, with low birth weight and child parasitic infectious disease burden demonstrated to be significantly associated with this indicator of chronic malnutrition. These results emphasize the multifaceted nature of stunted growth and the need to address both the prenatal and postnatal environmental factors that contribute to this problem.
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Affiliation(s)
- Shanique Martin
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | | | - Julia Sessions
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Justin Lee
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Dunstan Mukoko
- Vector-Borne Diseases Control Unit, Ministry of Health, Nairobi, Kenya
| | - Indu Malhotra
- Case Western Reserve University, Center for Global Health and Diseases, Cleveland, OH, USA
| | - Charles H King
- Case Western Reserve University, Center for Global Health and Diseases, Cleveland, OH, USA
| | - A Desiree LaBeaud
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
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Zeng Z, Huo X, Wang Q, Wang C, Hylkema MN, Xu X. PM 2.5-bound PAHs exposure linked with low plasma insulin-like growth factor 1 levels and reduced child height. Environ Int 2020; 138:105660. [PMID: 32199227 DOI: 10.1016/j.envint.2020.105660] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/27/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Exposure to atmospheric fine particle matter (PM2.5) pollution and the absorbed pollutants is known to contribute to numerous adverse health effects in children including to growth. OBJECTIVE The aim of this study was to evaluate exposure levels of atmospheric PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) in an electronic waste (e-waste) polluted town, Guiyu, and to investigate the associations between PM2.5-PAH exposure, insulin-like growth factor 1 (IGF-1) levels and child growth. METHODS This study recruited 238 preschool children (3-6 years of age), from November to December 2017, of which 125 were from Guiyu (an e-waste area) and 113 were from Haojiang (a reference area). Levels of daily PM2.5 and PM2.5-bound ∑16 PAHs were assessed to calculate individual chronic daily intakes (CDIs). IGF-1 and IGF-binding protein 3 (IGFBP-3) concentrations in child plasma were also measured. The associations and further mediation effects between exposure to PM2.5 and PM2.5-bound PAHs, child plasma IGF-1 concentration, and child height were explored by multiple linear regression models and mediation effect analysis. RESULTS Elevated atmospheric PM2.5-bound ∑16 PAHs and PM2.5 levels were observed in Guiyu, and this led to more individual CDIs of the exposed children than the reference (all P < 0.001). The median level of plasma IGF-1 in the exposed group was lower than in the reference group (91.42 ng/mL vs. 103.59 ng/mL, P < 0.01). IGF-1 levels were negatively correlated with CDIs of PM2.5, but not with CDIs of PM2.5-bound ∑16 PAHs after adjustment. An increase of 1 μg/kg of PM2.5 intake per day was associated with a 0.012 cm reduction of child height (95% CI: -0.014, -0.009), and similarly, an elevation of 1 ng/kg of PM2.5-bound ∑16 PAHs intake per day was associated with a 0.022 cm decrease of child height (95% CI: -0.029, -0.015), both after adjustment of several potential confounders (age, gender, family cooking oil, picky eater, eating sweet food, eating fruits or vegetables, parental education level and monthly household income). The decreased plasma IGF-1 concentration mediated 15.8% of the whole effect associated with PM2.5 exposure and 23.9% of the whole effect associated with PM2.5-bound ∑16 PAHs exposure on child height. CONCLUSION Exposure to atmospheric PM2.5-bound ∑16 PAHs and PM2.5 is negatively associated with child height, and is linked to reduced IGF-1 levels in plasma. This may suggest a causative negative role of atmospheric PM2.5-bound exposures in child growth.
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Affiliation(s)
- Zhijun Zeng
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, Shantou 515041, Guangdong, China; University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Xia Huo
- Laboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 511443, Guangdong, China
| | - Qihua Wang
- Laboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 511443, Guangdong, China
| | - Chenyang Wang
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Machteld N Hylkema
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Xijin Xu
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, Shantou 515041, Guangdong, China; Department of Cell Biology and Genetics, Shantou University Medical College, Shantou 515041, Guangdong, China.
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Mohammed SH, Habtewold TD, Abdi DD, Alizadeh S, Larijani B, Esmaillzadeh A. The relationship between residential altitude and stunting: evidence from >26 000 children living in highlands and lowlands of Ethiopia. Br J Nutr 2020; 123:934-41. [PMID: 31902383 DOI: 10.1017/S0007114519003453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Little information is known about the influence of altitude on child growth in Ethiopia, where most people live in highlands. We investigated the relation of residential altitude with growth faltering (stunting) of infants and young children in Ethiopia. We also examined whether the altitude-growth relationship was independent of the influence of the dietary and non-dietary determinants of growth. We used the data of 26 976 under-5-year-old children included in the Ethiopian Demographic and Health Surveys, conducted from 2005 to 2016. The samples were recruited following a two-stage cluster sampling strategy. Stunting was defined by height-for-age <-2 z-scores. The relationship between residential altitude and stunting was examined by running multiple logistic regression analysis, controlling the effect of covariate dietary and non-dietary variables. The residential altitude of the study participants ranged from -116 to 4500 m above sea level (masl). There was a significant and progressive increase in the prevalence and odds of stunting with increasing altitude (P < 0·001), irrespective of the dietary and non-dietary predictors of stunting. The prevalence of stunting was lowest in lowlands (39 %) and highest in highlands (47 %). Compared with altitude <1000 masl, the odds of stunting was 1·41 times higher at altitude ≥2500 masl (OR 1·41, 95 % CI 1·16, 1·71) and 1·29 times higher at altitude 2000-2499 masl (OR 1·29, 95 % CI 1·11, 1·49). Children living in highlands might be at a higher risk of poor growth. Further studies are warranted to understand the mechanism behind the observed altitude-stunting link and identify strategies to compensate for the growth-faltering effect of living in highlands.
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Haskins L, Chiliza J, Barker P, Connolly C, Phakathi S, Feeley A, Horwood C. Evaluation of the effectiveness of a quality improvement intervention to support integration of maternal, child and HIV care in primary health care facilities in South Africa. BMC Public Health 2020; 20:318. [PMID: 32164597 PMCID: PMC7069172 DOI: 10.1186/s12889-020-8397-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite policies and guidelines recommending integration of health services in South Africa, provision of maternal and child health services remains fragmented. This study evaluated a rapid, scaleable, quality improvement (QI) intervention to improve integration of maternal and child health and HIV services at a primary health level, in KwaZulu-Natal, South Africa. Methods A three-month intervention comprised of six QI mentoring visits, learning sessions with clinic staff to share learnings, and a self-administered checklist aimed to assist health workers monitor and implement an integrated package of health services for mothers and children. The study evaluated 27 clinics in four sub-districts using a stepped-wedge design. Each sub-district received the intervention sequentially in a randomly selected order. Five waves of data collection were conducted in all participating clinics between December 2016–February 2017. A multi-level, mixed effects logistic regression was used to account for random cluster fixed time and group effects using Stata V13.1. Results Improvements in some growth monitoring indicators were achieved in intervention clinics compared to control clinics, including measuring the length of the baby (77% vs 63%; p = 0.001) and health workers asking mothers about the child’s feeding (74% vs 67%; p = 0.003), but the proportion of mothers who received feeding advice remained unchanged (38% vs 35%; p = 0.48). Significantly more mothers in the intervention group were asked about their baby’s health (44% vs 36%; p = 0.001), and completeness of record keeping improved (40% vs 26%; I = < 0.0001). Discussions with the mother about some maternal health services improved: significantly more mothers in the intervention group were asked about HIV (26.5% vs 19.5%; p = 0.009) and family planning (33.5% vs 19.5%; p < 0.001), but this did not result in additional services being provided to mothers at the clinic visit. Conclusion This robust evaluation shows significant improvements in coverage of some services, but the QI intervention was unable to achieve the substantial changes required to provide a comprehensive package of services to all mothers and children. We suggest the QI process be adapted to complex under-resourced health systems, building on the strengths of this approach, to provide workable health systems strengthening solutions for scalable implementation. Trial registration ClinicalTrials.gov NCT04278612. Date of Registration: February 19, 2020. Retrospectively registered.
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Affiliation(s)
- Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Jessica Chiliza
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, South Africa. .,Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| | - Pierre Barker
- Institute for Healthcare Improvement, 53 State Street, Boston, MA, 02019, USA
| | - Catherine Connolly
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Sifiso Phakathi
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Alison Feeley
- UNICEF South Africa, Equity House, 659 Pienaar Street, Pretoria, South Africa.,MRC/WITS Developmental Pathways Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, South Africa
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Chakraborty B, Yousefzadeh S, Darak S, Haisma H. "We struggle with the earth everyday": parents' perspectives on the capabilities for healthy child growth in haor region of Bangladesh. BMC Public Health 2020; 20:140. [PMID: 32005210 PMCID: PMC6993497 DOI: 10.1186/s12889-020-8196-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/10/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Childhood stunting is an important public health problem in the haor region of Bangladesh. Haor areas are located in the north-eastern part of the country and are vulnerable to seasonal flooding. The key objective of this study is to identify the capabilities of the parents and their children that shape multidimensional child growth outcomes in the haor region in the first thousand days of life. METHODS A qualitative study was conducted in two sub-districts of the haor region, including in Derai in the Sunamganj district and Baniachang in the Habiganj district. We facilitated eight focus group discussions with the parents of children under age two. To allow us to explore individual stories, we conducted in-depth interviews with four fathers and four mothers. A capability framework to child growth was used in shaping the interview guides and analysing the data. RESULTS The findings were categorised at four levels: a) capabilities for the child, b) capabilities for the mother, c) capabilities for the father, and d) capabilities at the household level. At the child's level, the parents discussed the capability to stay away from disease and to eat well, the capability to stay happy and playful, and the capability to be born with God's blessings and the hereditary traits needed to grow in size. The mothers frequently mentioned the capability to stay healthy and nourished, to stay away from violence, and to practice autonomy in allocating time for child care. The fathers stressed the earning opportunities that are affected by long-term flooding and the loss of agricultural productivity. At the household level, they discussed the capability to live in a safe shelter, to be mobile, to overcome their struggles with the earth, and to have a source of safe drinking water. CONCLUSIONS The capability framework for child growth helped identify relevant capabilities in the haor region. These findings can guide discussions with communities and policy makers about developing programmes and interventions aimed at enhancing the identified capabilities for child growth in this vulnerable region.
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Affiliation(s)
- Barnali Chakraborty
- BRAC, 75, Mohakhali, Dhaka, Bangladesh. .,BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. .,Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747AD, Groningen, the Netherlands.
| | - Sepideh Yousefzadeh
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747AD, Groningen, the Netherlands.,Campus Fryslan, University of Groningen, Groningen, the Netherlands
| | | | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747AD, Groningen, the Netherlands
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Haisma H, Pelto G, Venkatapuram S, Yousefzadeh S, Kramer L, Anand P. Towards a Multi-Dimensional Index of Child Growth to Combat the Double Burden of Malnutrition. Ann Nutr Metab 2019; 75:123-126. [PMID: 31743928 DOI: 10.1159/000503670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is growing awareness in the field of public health that combatting the double burden of malnutrition requires approaches that address its multi-dimensional origin, rather than focusing primarily on the biomedical domain. Current frameworks of malnutrition like the UNICEF conceptual framework, and the Lancet Series 2013 framework have been instrumental in understanding the determinants of malnutrition and developing appropriate interventions. However, these frameworks fail to explicitly address issues of agency, that is, about being able to pursue one's goal. The capability approach as originally developed by Amartya Sen includes agency in the causal chain. Summary and key Messages: In the past 5 years, the International Union of Nutritional Sciences Task Force "Towards a multi-dimensional index for child growth and development" has developed a capability framework for child growth, and conducted empirical research applying this framework. The working group discussed what would be needed to further develop the approach and explained the added value to international organisations and policy makers. We suggest developing an index of advantage that will be a proxy for a child's agency. We hypothesise that such an index will explain much of the variance in studying inequalities in child nutrition and thus call for action to improve this focal point.
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Affiliation(s)
- Hinke Haisma
- Population Research Centre, University of Groningen, Groningen, The Netherlands,
| | - Gretel Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | | | - Sepideh Yousefzadeh
- Population Research Centre, University of Groningen, Groningen, The Netherlands
| | - Lybrich Kramer
- Department of Nutrition and Dietetics, Hanze University for Applied Sciences, Groningen, The Netherlands
| | - Paul Anand
- Faculty of Art and Social Sciences, Open University, London, United Kingdom
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Banerjee K, Dwivedi LK. Linkage in stunting status of siblings: a new perspective on childhood undernutrition in India. J Biosoc Sci 2020; 52:681-95. [PMID: 31707998 DOI: 10.1017/S0021932019000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Almost 30% of the world's stunted children reside in India. This study examined sibling linkage in childhood stunting by assessing the extent of clustering of stunted children born to the same mother. Data were taken from 225,002 children under the age of five from the Indian National Family and Health Survey (NFHS)-4 conducted in 2015-16. States with high fertility and lower socioeconomic development displayed higher clustering of childhood stunting among siblings. Simulating removal of this clustered burden showed an almost 10 percentage point reduction in stunting in India. Multinomial regression analysis highlighted that the propensity to have multiple stunted births was higher among less-educated women, scheduled caste/tribes and poor households. The multilevel model results indicated that the odds of stunting for the index child increased by 1.93 if the older sibling was stunted. The odds of the index child being stunted if the previous child was stunted were high, irrespective of the differences in state-level public health performances and political commitments. Although socioeconomic correlates play a crucial role in determining child stunting status, they also act as proxies for poor-quality intra-generational health. Clustering of stunting among siblings is an indicator of both genetic and environmental association with the height-for-age (HAZ) of children. Mothers with repeated stunted births should be prioritized and monitored over a substantial part of their lives. Inclusion of multiple child beneficiaries in nutrition policies and revisiting the 'one size fits all' concept at the micro level, owing to the substantial village/ward-level variation, might be an effective policy measure.
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Simonyan H, Sargsyan A, Balalian AA, Davtyan K, Gupte HA. Short-term nutrition and growth indicators in 6-month- to 6-year-old children are improved following implementation of a multidisciplinary community-based programme in a chronic conflict setting. Public Health Nutr 2020; 23:134-45. [PMID: 31694729 DOI: 10.1017/S1368980019002969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: We investigated short- and long-term indicators of malnutrition and diet before and after the community-based ‘Breaking the Cycle of Poverty’ multidisciplinary intervention. Design: A historically and geographically controlled study using data collected in 2013 and 2016. We compared the prevalence of short-term indicators (anaemia, breast-feeding duration and minimum dietary diversity) and long-term indicators (stunting and wasting) in exposed communities at two time points. We then compared these factors in geographic areas exposed or not exposed to intervention. We conducted logistic regression analyses on the 2016 sample to measure associations between living in intervention communities and child growth indicators. Setting: Berd region, a chronic conflict zone near the north-eastern border of Armenia and Azerbaijan. Participants: Children aged 6 months to 6 years. Results: Analyses included data from 2013 comprising 382 children, and data from 2016 comprising 348 children living in communities where the programme was implemented, and 635 children from unexposed communities. Anaemia prevalence in exposed communities was significantly lower in 2016 v. 2013 (10·9 v. 19·1 %, P < 0·01). Minimum dietary diversity (79·0 v. 68·1 %, P < 0·001) and breast-feeding duration (13·0 v. 11·5 months, P < 0·002) were significantly improved in exposed communities. Prevalences of stunting (11·5 v. 10·2 %, P = 0·57) and wasting (4·8 v. 2·0 %, P = 0·07) were not significantly different. Odds of anaemia were significantly lower (OR = 0·24, 95 % CI 0·16, 0·36) in intervention communities. Conclusions: Exposure to a community-based multidisciplinary intervention reduced the rate of anaemia and improved dietary indicators.
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Abdollahi M, Ajami M, Abdollahi Z, Kalantari N, Houshiarrad A, Fozouni F, Fallahrokni A, Mazandarani FS. Zinc supplementation is an effective and feasible strategy to prevent growth retardation in 6 to 24 month children: A pragmatic double blind, randomized trial. Heliyon 2019; 5:e02581. [PMID: 31720482 PMCID: PMC6839004 DOI: 10.1016/j.heliyon.2019.e02581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 11/05/2018] [Accepted: 10/02/2019] [Indexed: 02/08/2023] Open
Abstract
Background Zinc is an essential nutrient that is naturally available in most foods. Deficiency of this micronutrient in particular can cause a number of health complications. Zinc deficiency during infancy is more troublesome as rapid growth and nutrient relied development takes place in this period. Most severe outcomes of zinc deficiency during infancy are considered to be, impaired immunity, growth retardation and impaired neurodevelopment. The aim of this pragmatic study is to determine whether zinc supplementation strategy is feasible and effective for reducing growth retardation at national level. Methods A randomized, multicenter, double-blind, parallel group effectiveness trial that evaluated the effect of zinc supplementation in infant development. Children aged 6–24 months were recruited from healthcare centers of Damavand, Pishva and Varamin in the beginning of the study (n = 682). The Subjects were then randomly allocated in two groups of intervention (n = 272), and control (n = 308), where a daily dose of zinc sulfate (5ml) suspension containing 5mg elemental zinc and placebo were administered for the period of 6 month. Investigators, care givers and the parents of the children were blinded to the nature of the intervention. Anthropometric measures were evaluated at the beginning and after the six month intervention period. The primary outcome measured was linear growth and length difference, serum zinc and ferritin concentrations were the secondary outcomes. Findings Following the intervention, compared with the placebo, zinc supplementation was associated with significant difference in the average length increment (primary outcome) (placebo 5·23 ± 2·19 vs. intervention 5·79 ± 2·18 cm, p = 0·02). No significant difference was observed in concentrations of serum zinc and ferritin. After the intervention the prevalence of zinc deficiency was significantly lower in the intervention group compared to the placebo group. No complications and adverse effects were reported and the compliance was very good (7 children out of 344 didn't comply with the intake of syrup). Interpretation Zinc supplementation for six month among children (6–24 months) had beneficial outcomes on growth and average length increment, therefore we propose it is a feasible strategy for preventing growth retardation.
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Affiliation(s)
- Morteza Abdollahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Nutrition Research, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Ajami
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Abdollahi
- Nutrition Department, Undersecretary of Public Health Ministry of Health & Medical Education, Tehran, Iran
| | - Nasser Kalantari
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Houshiarrad
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Fozouni
- Department of Nutrition, Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Fallahrokni
- National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nawa N, Black MM, Araya R, Richiardi L, Surkan PJ. Pre- and post-natal maternal anxiety and early childhood weight gain. J Affect Disord 2019; 257:136-42. [PMID: 31301614 DOI: 10.1016/j.jad.2019.06.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/25/2019] [Accepted: 06/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND While maternal depression has been linked to impaired child growth, the relationship between anxiety and child weight gain is unknown. The study objective was to investigate maternal pre- and post-natal anxiety in relation to child weight gain. METHODS Data included 1168 children in the Avon Longitudinal Study of Parents and Children. Child height and weight were measured at the median ages of 25 and 31 months postnatally and used to calculate body mass index (BMI). Maternal anxiety was measured with the Crown-Crisp Experiential Index at 18 and 32 gestational weeks, and two and 21 months postpartum. Mothers scoring in the top 15% at one or more of the four time points were considered to have anxiety. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale-7 (EPDS-7) at these same time points. Maternal depression was defined as EPDS-7 scores of >10. We used Generalized Estimating Equations to assess whether child BMI trajectories varied by the presence of maternal anxiety. Parallel analyses were conducted for maternal depression. RESULTS Among children of mothers who had anxiety at least at one timepoint, the BMI changes associated with a three-month increase in child age increased by 0.06 (95% CI:0.004-0.12) compared to BMI changes in children of mothers without anxiety. Maternal depressive symptoms were not associated with child BMI trajectories. LIMITATIONS Maternal anxiety and depressive symptoms were based on maternal self-report. CONCLUSION Maternal anxiety around childbirth was associated with modest increases in child BMI gain during the child's second year of life.
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Miller LC, Neupane S, Joshi N, Lohani M, Rogers BL, Neupane S, Ghosh S, Webb P. Multisectoral community development in Nepal has greater effects on child growth and diet than nutrition education alone. Public Health Nutr 2020; 23:146-61. [PMID: 31544735 DOI: 10.1017/S136898001900260X] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the impact on child diet and growth of a multisectoral community intervention v. nutrition education and livestock management training alone. DESIGN Longitudinal community-based randomized trial involving three groups of villages assigned to receive: (i) Full Package community development activities, delivered via women's groups; (ii) livestock training and nutrition education alone (Partial Package); or (iii) no intervention (Control). Household surveys, child growth monitoring, child and household diet quality measures (diet diversity (DD), animal-source food (ASF) consumption) were collected at five visits over 36 months. Mixed-effect linear regression and Poisson models used survey round, treatment group and group-by-round interaction to predict outcomes of interest, adjusted for household- and child-specific characteristics. SETTING Banke, Nepal. PARTICIPANTS Households (n 974) with children aged 1-60 months (n 1333). RESULTS Children in Full Package households had better endline anthropometry (weight-for-age, weight-for-height, mid-upper-arm-circumference Z-scores), DD, and more consumption of ASF, after adjusting for household- and child-specific characteristics. By endline, compared with Partial Package or Control groups, Full Package households demonstrated preferential child feeding practices and had significantly more improvement in household wealth and hygiene habits. CONCLUSIONS In this longitudinal study, a comprehensive multisectoral intervention was more successful in improving key growth indicators as well as diet quality in young children. Provision of training in livestock management and nutrition education alone had limited effect on these outcomes. Although more time-consuming and costly to administer, incorporating nutrition training with community social capital development was associated with better child growth and nutrition outcomes than isolated training programmes alone.
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Tran TD, Holton S, Nguyen H, Fisher J. Physical growth: is it a good indicator of development in early childhood in low- and middle-income countries? BMC Pediatr 2019; 19:276. [PMID: 31395035 PMCID: PMC6686501 DOI: 10.1186/s12887-019-1654-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 07/31/2019] [Indexed: 11/25/2022] Open
Abstract
Background Growth and early development (ECD) are vital outcomes for children. This study aimed to examine the association between child growth and overall development in children aged 3 to 5 years in low- and middle-income countries. Methods A secondary analysis of nationally representative data collected in UNICEF’s Multiple Indicator Cluster Surveys (MICS) and national Demographic and Health Surveys (DHS). The early development of children aged 3 to 5 years from the randomly selected households was ascertained using a 10-item scale which assessed four developmental domains: language-cognitive, physical, socio-emotional, and approaches to learning with a total development score ranging from 0 (the least optimal) to 10 (the most optimal). Children’s growth, the height-for-age Z score (HAZ), was calculated using the WHO Child Growth Standards. Unadjusted (Pearson’s correlation coefficient, r) and adjusted estimations (standardised mean difference (SMD) adjusted for child sex, child age, and household wealth index) of the magnitude of the association between HAZ and ECD scores were calculated for each country. Results Data contributed by 178,393 children aged 36 to 59 months from 55 countries were included in the analyses. The pooled r between HAZ and standardised ECD scores was 0.12 and the pooled adjusted SMD was 0.06. The r ranged from ~ 0 in Barbados, Lebanon, and Moldova to 0.32 in Pakistan and 0.36 in Nigeria. Overall, 47/55 countries had correlation coefficients less than the cut-off for a small association. The adjusted SMDs were ~ 0 in 20 countries. All SMDs were lower than the cut-off for a small effect size. The magnitudes of the association were highest in South Asia and lowest in Middle East and North Africa, and lowest in the highest HDI group. Conclusions The association between growth and development in early childhood appears to be primarily a co-occurrence because the magnitude of the association varies among settings from no association in higher-income countries to a moderate level in low-income countries. In low-income countries, interventions targeting child growth and ECD should be integrated given their common risks frequency in these settings. Overall, growth is not a sensitive and therefore suitable indicator of child development. Electronic supplementary material The online version of this article (10.1186/s12887-019-1654-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thach Duc Tran
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Sara Holton
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Hau Nguyen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Duc LT. Household wealth and gender gap widening in height: Evidence from adolescents in Ethiopia, India, Peru, and Vietnam. Econ Hum Biol 2019; 34:208-215. [PMID: 31176581 DOI: 10.1016/j.ehb.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
This study investigates the relationship between household wealth and child height utilizing longitudinal data on 7150 children from Ethiopia, India, Peru, and Vietnam. The concept of conditional wealth is applied to separate the influence of wealth in early childhood. Conditional wealth is the change in wealth that was unpredicted at the age of 5 years. This study finds two dimensions of heterogeneity in the wealth-gradient of adolescent height: gender and stunting status at the age of 5 years. For all four countries in the study, the effect of conditional wealth on adolescent height is stronger for boys than for girls. The estimates for the pooled sample indicate that after the age of 5 years, the growth of children who were stunted at that age is significantly more responsive to conditional wealth than the growth of non-stunted children. The analysis results show that for boys in Ethiopia, a one-standard-deviation increase in preadolescence wealth is associated with an increase of 1 cm (standard error [SE]: 0.3) in height at the age of 15 years. For boys in the Indian state of Andhra Pradesh, Peru, and Vietnam, the corresponding figures are 1.1 cm (SE: 0.4), 1.8 cm (SE: 0.4), and 1.2 cm (SE: 0.4), respectively. The effect of preadolescence wealth on adolescent height is not statistically significant for girls, except in some regions. Overall, the results suggest that household wealth in preadolescence disproportionately benefits the male population in these countries when using height as a proxy for health.
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Affiliation(s)
- Le Thuc Duc
- Centre for Analysis and Forecasting, Vietnam Academy of Social Sciences, #1 Lieu Giai Road, Ha Noi, Viet Nam.
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Faye CM, Fonn S, Levin J, Kimani-Murage E. Analysing child linear growth trajectories among under-5 children in two Nairobi informal settlements. Public Health Nutr 2019; 22:2001-11. [PMID: 30940271 DOI: 10.1017/S1368980019000491] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We sought to identify factors associated with linear growth among under-5 children in two urban informal settlements in Nairobi. DESIGN We used longitudinal data for the period 2007-2012 from under-5 children recruited in the two sites between birth and 23 months and followed up until they reached 5 years of age. We fitted a generalized linear model on height-for-age Z-scores using the generalized estimating equations method to model linear growth trajectories among under-5 children. Known for its flexibility, the model provides strong parameter estimates and accounts for correlated observations on the same child. SETTING Two urban informal settlements in Nairobi, Kenya.ParticipantsUnder-5 children (n 1917) and their mothers (n 1679). RESULTS The findings show that child weight at birth, exclusive breast-feeding and immunization status were key determinants of linear growth among under-5 children. Additionally, maternal characteristics (mother's age, marital status) and household-level factors (socio-economic status, size of household) were significantly associated with child linear growth. There were biological differences in linear growth, as female children were more likely to grow faster than males. Finally, the model captured significant household-level effects to investigate further. CONCLUSIONS Findings from the study point to the need to improve the targeting of child health programmes directed at the urban poor population in Nairobi. Specific modifiable determinants of child linear growth, particularly child weight at birth, exclusive breast-feeding, immunization status and mother's background characteristics, should be considered when designing interventions aiming at addressing child health inequities in these settings.
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Pan XF, Tang L, Lee AH, Binns C, Yang CX, Xu ZP, Zhang JL, Yang Y, Wang H, Sun X. Association between fetal macrosomia and risk of obesity in children under 3 years in Western China: a cohort study. World J Pediatr 2019; 15:153-60. [PMID: 30635839 DOI: 10.1007/s12519-018-0218-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fetal macrosomia, defined as birth weight equal or over 4000 g, is a major concern for both neonatal and maternal health. A rapid increasing trend in fetal macrosomia is observed in different regions of China. We aimed to examine the association between fetal macrosomia and risk of childhood obesity in Western China. METHODS All macrosomic live singletons (≥ 4000 g), and a random sample of singletons with normal birth weight (2500-3999 g) born in four districts of Chengdu, Western China, in 2011 were included in the cohort study. Maternal demographics, obstetric factors, labor and delivery summary at baseline were extracted from the Chengdu Maternal and Child Health Management System. Anthropometric measurements before 3 years and infant feeding information at around 6 months were also collected. Childhood obesity under 3 years was primarily defined as a weight-for-length/height z score ≥ 1.645 using the WHO growth reference. Secondary definitions were based on weight-for-age and body mass index (BMI)-for-age over the same cut-offs. RESULTS A total of 1767 infants were included in the analyses, of whom 714 were macrosomic. After controlling for maternal age, parity, gestational age and anemia at the first antenatal visit, pre-pregnancy BMI, gestational weight gain, gestational age at birth, baby age and sex, and breastfeeding practices at 6 months, the risk of childhood obesity defined according to weight-for-length/height among macrosomic babies was 1.90 (95% confidence interval 1.04-3.49) times that of babies with normal birth weight. The risk of childhood obesity for macrosomic babies was 3.74 (1.96-7.14) and 1.64 (0.89-3.00) times higher based on weight-for-age and BMI-for-age, respectively. CONCLUSION Fetal macrosomia is associated with increased risk of obesity in children under 3 years in Western China.
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Pfeiffer S, Harrington L, Lombard M. The people behind the samples: Biographical features of Past Hunter-Gatherers from KwaZulu-Natal who yielded aDNA. Int J Paleopathol 2019; 24:158-164. [PMID: 30399480 DOI: 10.1016/j.ijpp.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/18/2018] [Accepted: 10/25/2018] [Indexed: 05/25/2023]
Abstract
PURPOSE Skeletons sampled for ancient human DNA analysis are sometimes complete enough to provide information about the lives of the people they represent. We focus on three Later Stone Age skeletons, ca. 2000 B.P., from coastal KwaZulu-Natal, South Africa, whose ancient genomes have been sequenced (Schlebusch et al., 2017). METHODS Bioarchaeological approaches are integrated with aDNA information. RESULTS All skeletons are male. Dental development shows that the boy, with prominent cribra orbitalia, died at age 6-7 years. Two men show cranial and spinal trauma, extensive tooth wear, plus mild cribra orbitalia in one. CONCLUSIONS Dental wear and trauma of the adults are consistent with hunter-gatherer lives. Even partial aDNA evidence contributes to sex determination. Parasitic infection such as schistosomiasis is the best-fit cause for the child's anemia in this case. CONTRIBUTION TO KNOWLEDGE The convergence of genomic and bioarchaeological approaches expands our knowledge of the past lives of a boy and two men whose lives as hunter-gatherers included episodes of trauma and disease. LIMITATIONS The skeletons are incomplete, in variable condition, and from poorly characterized local cultural contexts. SUGGESTIONS FOR FURTHER RESEARCH Thorough osteobiographic analysis should accompany paleogenomic investigations. Such disciplinary collaboration enriches our understanding of the human past.
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Affiliation(s)
- Susan Pfeiffer
- Department of Anthropology, University of Toronto, 19 Russell Street, Toronto, M5S 2S2, Canada; Department of Archaeology, University of Cape Town, Rondebosch 7701, South Africa; Department of Anthropology, George Washington University, D.C., USA.
| | - Lesley Harrington
- Department of Anthropology, University of Alberta, 13-15 H.M. Tory Building, Edmonton, T6G 2H4, Canada
| | - Marlize Lombard
- Centre for Anthropological Research, University of Johannesburg, P.O. Box 524, Auckland Park, 2006, South Africa
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Boyette AH, Lew-Levy S, Sarma MS, Gettler LT. Testosterone, fathers as providers and caregivers, and child health: Evidence from fisher-farmers in the Republic of the Congo. Horm Behav 2019; 107:35-45. [PMID: 30268885 DOI: 10.1016/j.yhbeh.2018.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/15/2018] [Accepted: 09/25/2018] [Indexed: 01/24/2023]
Abstract
Males in vertebrate species with biparental care commonly face a life history trade-off between investing in mating versus parenting effort. Among these males, testosterone is frequently elevated during mating and competition and reduced when males help raise offspring. These physiological patterns may be adaptive, increasing males' fitness through investments in young. However, for some species, including humans, indirect parenting often benefits young but can also involve male competition and risk-taking behavior and may be facilitated by elevated testosterone. Despite potential adaptive functions of biological responses to invested fatherhood, few if any mammalian studies have linked fathers' testosterone to offspring outcomes; no studies in humans have. Using data from a small-scale society of fisher-farmers from the Republic of the Congo, we find that fathers who were rated as better providers by their peers had higher testosterone, compared to other fathers in their community. However, children whose fathers had middle-range T compared to fathers with higher or lower levels had better energetic status (higher BMI; greater triceps skinfold thickness). Fathers' indirect and direct care helped to account for these associations between paternal T and children's energetic profiles. Given that human paternal direct and, especially, indirect care are thought to have been important evolutionarily and remain so in many contemporary societies, these findings help to shed light on the facultative nature of human biological responses to fatherhood and the relevance of these factors to children's well-being.
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Affiliation(s)
- Adam H Boyette
- Thompson Writing Program, Duke University, Box 90025, Durham, NC 27708, USA.
| | - Sheina Lew-Levy
- Department of Psychology, University of Cambridge, Free School Lane CB2 3RQ, United Kingdom.
| | - Mallika S Sarma
- Department of Anthropology, University of Notre Dame, 244 Corbett Hall, Notre Dame, IN 46556, USA.
| | - Lee T Gettler
- Department of Anthropology, University of Notre Dame, 244 Corbett Hall, Notre Dame, IN 46556, USA; Eck Institute for Global Health, USA; William J. Shaw Center for Children and Families, University of Notre Dame, 244 Corbett Hall, Notre Dame, IN 46556, USA.
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Quelhas D, Kompala C, Wittenbrink B, Han Z, Parker M, Shapiro M, Downs S, Kraemer K, Fanzo J, Morris S, Kreis K. The association between active tobacco use during pregnancy and growth outcomes of children under five years of age: a systematic review and meta-analysis. BMC Public Health 2018; 18:1372. [PMID: 30545322 PMCID: PMC6293508 DOI: 10.1186/s12889-018-6137-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/19/2018] [Indexed: 11/15/2022] Open
Abstract
Background Despite considerable global efforts to reduce growth faltering in early childhood, rates of stunting remain high in many regions of the world. Current interventions primarily target nutrition-specific risk factors, but these have proven insufficient. The objective of this study was to synthesize the evidence on the relationship between active tobacco use during pregnancy and growth outcomes in children under five years of age. Methods In this systematic review and meta-analysis, six online databases were searched to identify studies published from January 1, 1980, through October 31, 2016, examining the association between active tobacco use during pregnancy and small-for-gestational age (SGA), length/height, and/or head circumference. Ecological studies were not included. A meta-analysis was conducted, and subgroup analyses were carried out to explore the effect of tobacco dosage. Results Among 13,189 studies identified, 210 were eligible for inclusion in the systematic review, and 124 in the meta-analysis. Active tobacco use during pregnancy was associated with significantly higher rates of SGA (pooled adjusted odds ratio [AORs] = 1.95; 95% confidence interval [CI]: 1.76, 2.16), shorter length (pooled weighted mean difference [WMD] = 0.43; 95% CI: 0.41, 0.44), and smaller head circumference (pooled WMD = 0.27; 95% CI: 0.25, 0.29) at birth. In addition, a dose-response effect was evident for all growth outcomes. Conclusion Tobacco use during pregnancy may represent a major preventable cause of impaired child growth and development. Electronic supplementary material The online version of this article (10.1186/s12889-018-6137-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diana Quelhas
- Nutrition Innovation, PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Chytanya Kompala
- Nutrition Innovation, PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Brittney Wittenbrink
- Nutrition Innovation, PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Zhen Han
- Nutrition Innovation, PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Megan Parker
- Nutrition Innovation, PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA.
| | - Myra Shapiro
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Shauna Downs
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Baltimore, MD, 21205, USA
| | - Klaus Kraemer
- Sight and Life Foundation, PO Box 2116, 4002, Basel, Switzerland
| | - Jessica Fanzo
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.,Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Baltimore, MD, 21205, USA
| | - Saul Morris
- GAIN, Churchill House, 142-146 Old Street, London, EC1V 9BW, UK
| | - Katharine Kreis
- Nutrition Innovation, PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
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Hann M, Roberts SA, D'Souza SW, Clayton P, Macklon N, Brison DR. The growth of assisted reproductive treatment-conceived children from birth to 5 years: a national cohort study. BMC Med 2018; 16:224. [PMID: 30482203 DOI: 10.1186/s12916-018-1203-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Birth weight and early child growth are important predictors of long-term cardiometabolic disease risk, in line with the Developmental Origins of Health and Disease hypothesis. As human assisted reproductive technologies (ARTs) occur during the sensitive periconceptional window of development, it has recently become a matter of urgency to investigate risk in ART-conceived children. METHODS We have conducted the first large-scale, national cohort study of early growth in ART children from birth to school age, linking the register of ART, held by the UK's Human Fertilisation and Embryology Authority, to Scottish maternity and child health databases. RESULTS In this study of 5200 ART and 20,800 naturally conceived (NC) control children, linear regression analysis revealed the birthweight of babies born from fresh embryo transfer cycles is 93.7 g [95% CI (76.6, 110.6)g] less than NC controls, whereas babies born from frozen embryo transfer (FET) cycles are 57.5 g [95% CI (30.7, 86.5)g] heavier. Fresh ART babies grew faster from birth (by 7.2 g/week) but remained lighter (by 171 g), at 6-8 weeks, than NC babies and 133 g smaller than FET babies; FET and NC babies were similar. Length and occipital-frontal circumference followed the same pattern. By school entry (4-7 years), weight, length and BMI in boys and girls conceived by fresh ART and FET were similar to those in NC children. CONCLUSIONS ART babies born from fresh embryo transfer grow more slowly in utero and in the first few weeks of life, but then show postnatal catch up growth by school age, compared to NC and FET babies. As low birth weight and postnatal catch-up are independent risk factors for cardiometabolic disease over the life-course, we suggest that further studies in this area are now warranted.
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Watson S, Moore SE, Darboe MK, Chen G, Tu YK, Huang YT, Eriksen KG, Bernstein RM, Prentice AM, Wild CP, Xu Y, Routledge MN, Gong YY. Impaired growth in rural Gambian infants exposed to aflatoxin: a prospective cohort study. BMC Public Health 2018; 18:1247. [PMID: 30413157 PMCID: PMC6234772 DOI: 10.1186/s12889-018-6164-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/30/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Exposure to aflatoxin, a mycotoxin produced by fungi that commonly contaminates cereal crops across sub-Saharan Africa, has been associated with impaired child growth. We investigated the impact of aflatoxin exposure on the growth of Gambian infants from birth to two years of age, and the impact on insulin-like growth factor (IGF)-axis proteins. METHODS A subsample (N = 374) of infants from the Early Nutrition and Immune Development (ENID) trial (ISRCTN49285450) were included in this study. Aflatoxin-albumin adducts (AF-alb) were measured in blood collected from infants at 6, 12 and 18 months of age. IGF-1 and IGFBP-3 were measured in blood collected at 12 and 18 months. Anthropometric measurements taken at 6, 12, 18 and 24 months of age were converted to z-scores against the WHO reference. The relationship between aflatoxin exposure and growth was analysed using multi-level modelling. RESULTS Inverse relationships were observed between lnAF-alb and length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) z-scores from 6 to 18 months of age (β = - 0·04, P = 0·015; β = - 0·05, P = 0.003; β = - 0·06, P = 0·007; respectively). There was an inverse relationship between lnAF-alb at 6 months and change in WLZ between 6 and 12 months (β = - 0·01; P = 0·013). LnAF-alb at 12 months was associated with changes in LAZ and infant length between 12 and 18 months of age (β = - 0·01, P = 0·003; β = - 0·003, P = 0·02; respectively). LnAF-alb at 6 months was associated with IGFBP-3 at 12 months (r = - 0·12; P = 0·043). CONCLUSIONS This study found a small but significant effect of aflatoxin exposure on the growth of Gambian infants. This relationship is not apparently explained by aflatoxin induced changes in the IGF-axis.
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Affiliation(s)
- Sinead Watson
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Sophie E. Moore
- Division of Women’s Health, King’s College London, London, UK
- MRC Unit The Gambia, Serekunda, Gambia
| | | | - Gaoyun Chen
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Huang
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kamilla G. Eriksen
- MRC Elsie Widdowson Laboratory, Cambridge, UK
- University of Copenhagen, Copenhagen, Denmark
| | | | - Andrew M. Prentice
- MRC Unit The Gambia, Serekunda, Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ya Xu
- School of Medicine, University of Leeds, Leeds, LS2 9JT UK
| | | | - Yun Yun Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
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Husseini M, Darboe MK, Moore SE, Nabwera HM, Prentice AM. Thresholds of socio-economic and environmental conditions necessary to escape from childhood malnutrition: a natural experiment in rural Gambia. BMC Med 2018; 16:199. [PMID: 30382849 PMCID: PMC6211595 DOI: 10.1186/s12916-018-1179-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Childhood malnutrition remains highly prevalent in low-income countries, and a 40% reduction in under-5 year stunting is WHO's top Global Target 2025. Disappointingly, meta-analyses of intensive nutrition interventions reveal that they generally have low efficacy at improving growth. Unhygienic environments also contribute to growth failure, but large WASH Benefits and SHINE trials of improved water, sanitation and hygiene (WASH) recently reported no benefits to child growth. METHODS To explore the thresholds of socio-economic status (SES) and living standards associated with malnutrition, we exploited a natural experiment in which the location of our research centre within a remote rural village created a wide diversity of wealth, education and housing conditions within the same ecological setting and with free health services to all. A composite SES score was generated by grading occupation, education, income, water and sanitation, and housing and families were allocated to 5 groups (SES1 = highest). SES ranged from very poor subsistence-farming villagers to post graduate staff with overseas training. Nutritional status at 24 m was obtained from clinic records for 230 children and expressed relative to WHO Growth Standards. RESULTS Height-for-age (HAZ) and weight-for-age (WAZ) Z-scores were strongly predicted by SES group. HAZ varied from - 0.67 to - 2.23 (P < 0.001) and WAZ varied from - 0.90 to - 1.64 (P < 0.001), from SES1 to SES5, respectively. Weight-for-height (WHZ) showed no gradient. Children in SES1 showed greater dispersion so were further divided in a post hoc analysis. Children resident in Western housing on the research compound (SES1A) had HAZ = + 0.68 and WAZ = + 0.36. The residual gradient between those in SES1B and SES5 spanned only 0.65 Z-score for HAZ (- 1.58 to - 2.23) and was not significant for WAZ or WHZ. CONCLUSIONS The large difference in growth between children in SES1A living in Western-type housing and SES1B children living in the village, and the very shallow gradient between SES1B and SES5, implies a very high SES threshold before stunting and underweight will be eliminated. This may help to explain the lack of efficacy of the recent WASH interventions and points to the need for what is termed 'Transformative WASH'. Good quality housing, with piped water into the home, may be key to eliminating malnutrition.
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Affiliation(s)
- Mayya Husseini
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
- Regional Activity Centre for Sustainable Consumption and Production (SCP/RAC), Sant Pau Art Nouveau Site, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Momodou K Darboe
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
| | - Sophie E Moore
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Helen M Nabwera
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia.
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Abstract
There appears to be increasing evidence of the relationship between infant feeding practices and growth during infancy. Effective complementary feeding has demonstrated an observable positive effect on the linear growth of a child within the first 24 months of life. It appears that improved complementary feeding is directly proportional to the linear growth of a child. Fortification of commonly used food vehicles provides an opportunity for increasing nutrient intake during infancy and has the potential to improve growth and development dimensions. This review scanned through 186 articles from common search engines, mainly PubMed, BioMed Central, and Google Scholar. The result based on a systematic review of articles which met the minimum selection criteria identified milk, iodine, maize meal porridge, and vegetable oils as recurring fortification vehicles in the context of complementary feeding. A significant impact of fortification on linear and cognitive growth was demonstrated recurrently across the included empirical studies. However, the review reflects outcomes that still do not demonstrate direct cause and effect relationships but rather implied meaning in the relationship matrix.
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50
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Ogasawara K. The long-run effects of pandemic influenza on the development of children from elite backgrounds: Evidence from industrializing Japan. Econ Hum Biol 2018; 31:125-137. [PMID: 30265896 DOI: 10.1016/j.ehb.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/01/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
This study estimates the lingering effects of fetal exposure to the 1918 influenza pandemic on the development of secondary school and girls' high school students in industrializing Japan. In order to refine the verification of the fetal origins hypothesis, we tried not only to focus on children from elite schools but also to construct the continuous influenza mortality measure using monthly variations in the number of births and influenza deaths. By utilizing a nationwide multidimensional physical examination dataset, we found that fetal exposure to influenza in the pandemic years reduced the heights of boys and girls by approximately 0.3 cm and 0.1 cm, respectively. While the strongest negative magnitude was observed in the pandemic period, the lingering relapses in the post-pandemic period still had considerable adverse effects on height. In relation to the lowest decile group which experienced normal influenza mortality in non-pandemic years, the heights of the boys and girls who experienced pandemic influenza in the womb are approximately 0.6 and 0.3 cm lower. The lingering influenza relapse in the post-pandemic period has an adverse effect on the boys' height, accounting for roughly 80% of the maximum pandemic effect.
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Affiliation(s)
- Kota Ogasawara
- Graduate School of Social Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba 263-8522, Japan.
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