Infections and nutrient deficiencies during infancy predict impaired growth at 5 years: Findings from the MAL-ED study in Pakistan

Frontiers in Nutrition

Nutrition

Arjumand Rizvi¹  Imran Chauhadry¹  Sajid Bashir Soofi¹  Simon Cousens²  Doris González-Fernández³  Zulfiqar Ahmed Bhutta⁴ 

[1] Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan;Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom;SickKids Centre for Global Child Health, Toronto, ON, Canada;SickKids Centre for Global Child Health, Toronto, ON, Canada;Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan;Institute for Global Health and Development, The Aga Khan University, London, United Kingdom;

关键词: child growth;    breastfeeding;    complementary feeding;    illness;    environmental enteropathy;    socio-demographic characteristics;    intestinal infections;    respiratory infection;   

DOI  :  10.3389/fnut.2023.1104654

 received in 2022-11-21, accepted in 2023-01-10,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundSocio-economic, nutritional, and infectious factors have been associated with impaired infant growth, but how the presence of these factors during infancy affects growth around 5 years is not well understood.MethodsThis secondary analysis of the MAL-ED cohort included 277 children from Pakistan for whom socio-demographic, breastfeeding, complementary foods, illness, nutritional biomarkers, stool pathogens and environmental enteropathy indicators between 0 and 11 months were recorded. We used linear regression models to analyze associations of these indicators with height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WLZ) at 54–66 months (~5 years), and Poisson regression with robust standard errors to estimate risk ratios for stunting and underweight ~5 years, controlling for gender, first available weight, and income.ResultsAmong the 237 infants followed longitudinally and evaluated at about 5 years of age, exclusive breastfeeding was short (median = 14 days). Complementary feeding started before 6 months with rice, bread, noodles, or sugary foods. Roots, dairy products, fruits/vegetables, and animal-source foods were provided later than recommended (9–12 months). Anemia (70.9%), deficiencies in iron (22.0%), zinc (80.0%), vitamin A (53.4%) and iodine (13.3%) were common. Most infants (>90%) presented with diarrhea and respiratory infections in their first year. At ~5 years, low WAZ (mean-1.91 ± 0.06) and LAZ (−2.11 ± 0.06) resulted in high prevalence of stunting (55.5%) and underweight (44.4%) but a relatively low rate of wasting (5.5%). While 3.4% had concurrent stunting and wasting ~5 years, 37.8% of children had coexisting stunting and underweight. A higher income and receiving formula or dairy products during infancy were associated with a higher LAZ ~5 years, but infant’s history of hospitalizations and more respiratory infections were associated with lower LAZ and higher risk of stunting ~5 years. Infants’ intake of commercial baby foods and higher serum-transferrin receptors were associated with higher WAZ and lower risk of underweight ~5 years. Presence of Campylobacter and fecal neopterin >6.8 nmol/L in the first year were associated with increased risk of underweight ~5 years.ConclusionGrowth indicators ~5 years were associated with poverty, inappropriate complementary feeding, and infections during the first year of life, which supports the early start of public health interventions for preventing growth delay ~5 years.

【 授权许可】

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Copyright © 2023 González-Fernández, Cousens, Rizvi, Chauhadry, Soofi and Bhutta.