ESPEYB21 15. Editors’ Choice New Concerns (4 abstracts)
15.8. Causes and consequences of child growth faltering in low-resource settings
Mertens A , Benjamin-Chung J , Colford JM , Jr. , Coyle J , van der Laan MJ , Hubbard AE , Rosete S , Malenica I , Hejazi N , Sofrygin O , Cai W , Li H , Nguyen A , Pokpongkiat NN , Djajadi S , Seth A , Jung E , Chung EO , Jilek W , Subramoney V , Hafen R , Haggstrom J , Norman T , Brown KH , Christian P , Arnold BF & The Ki Child Growth Consortium.
Nature 621(7979): 568–576 (2023). PubMed: 37704722
In Brief: The authors perform a population intervention effects analysis of 33 longitudinal cohorts (total 83 671 children, 662 763 measurements), from 15 low- and middle-income counties (LMICs). They estimate that improving maternal anthropometry and child condition at birth would increase population mean length-for-age z-scores by up to 0.40 and weight-for-length z -scores by up to 0.15 by 24 months of age.
This is 1 of 3 full articles published in Nature in September 2023. The other 2 articles documented the high incidence of childhood wasting and stunting (the highest incidence of both were by age 3 months) and their adverse consequences (persistent growth faltering and child mortality). The studies are funded by the Bill & Melinda Gates Foundation’s Knowledge Integration (ki) initiative, which aims to promote growth and development during the first 1,000 days of life, from conception.
Such prominent attention to this topic is welcome. Despite much research and international efforts, interventions to prevent stunting and wasting have only modest effects. The authors conjecture this is due to incomplete understanding of the optimal manner and timing of interventions. For example, there was surprisingly little estimated benefit of exclusive or predominant breastfeeding, or of reducing diarrhoea during the first 24 months.
Instead, after considering 30 separate exposures, the key findings highlight the importance of improving prenatal exposures – taller maternal height and larger child birth size. This will require long-term investments to support broad improvements in living standards, and throughout the mother’s childhood. Accordingly, the countries that have shown the greatest reductions in stunting have undergone improvements in maternal education, nutrition and maternal and newborn healthcare and reductions in the number of pregnancies.
Volume 21
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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