Associations of Enteric Protein Loss, Vaccine Response, Micronutrient Deficiency, and Maternal Depressive Symptoms with Deviance in Childhood Linear Growth: Results from a Multicountry Birth Cohort Study

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  • 1 Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;
  • | 2 Liggins Institute, University of Auckland, Auckland, New Zealand;
  • | 3 Haydom Global Health Institute, Haydom, Tanzania;
  • | 4 James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh;
  • | 5 Department of Global Health, University of Washington, Seattle, Washington;
  • | 6 Department of Public Health Nutrition, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh;
  • | 7 Office of Executive Director, icddr,b, Dhaka, Bangladesh

We identified the determinants of positive (children who had a birth weight < 2.5 kg and/or maternal height < 145 cm but were nonstunted at 24 months of age) and negative (children who had a birth weight ≥ 2.5 kg and maternal height ≥ 145 cm but were stunted at 24 months of age) deviance in childhood linear growth. We found that socioeconomic status (β = 1.54, P < 0.01), serum retinol (β = 0.05, P < 0.01), hemoglobin (β = 0.36, P < 0.01), length-for-age Z-score (LAZ) at birth (β = 0.47, P < 0.01), and tetanus vaccine titer (β = 0.182, P < 0.05) were positively and maternal depressive symptom (β = –0.05, P < 0.01), serum ferritin (β = –0.03, P < 0.01), male sex (β = –1.08, P < 0.01), and α1-antitrypsin (β = –0.81, P < 0.01) were negatively associated with positive deviance. Further, diarrhea episodes (β = 0.02, P < 0.01), male sex (β = 0.72, P < 0.01), and α1-antitrypsin (β = 0.67, P < 0.01) were positively and hemoglobin (β= –0.28, P < 0.01), soluble transferrin receptor level (β = –0.15, P < 0.01), and LAZ score at birth (β = –0.90, P < 0.01) were negatively associated with negative deviance. To summarize, enteric protein loss, micronutrient deficiency, vaccine responses and maternal depressive symptoms were associated with linear growth deviance in early childhood. In such a background, public health approaches aimed at reducing the risk of intestinal inflammation and altered gut permeability could prove fruitful in ensuring desired linear growth in children. In addition, maternal mental health issue should also be considered, especially for promoting better nutritional status in children in the context of linear growth deviance.

Author Notes

Address correspondence to Subhasish Das, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh. E-mail: subhasish.das@icddrb.org

Financial support: The MAL-ED birth cohort study was funded by the Foundation of National Institute of Health, Fogarty International Centre, with overall support from the Bill & Melinda Gates Foundation, grant no. GR-681.

Authors’ addresses: Subhasish Das, Visnu Pritom Chowdhury, Md. Amran Gazi, Shah Mohammad Fahim, Md. Ashraful Alam, Mustafa Mahfuz, and Tahmeed Ahmed, Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: subhasish.das@icddrb.org, visnu.pritom@icddrb.org, amran.gazi@icddrb.org, mohammad.fahim@icddrb.org, mashraful@icddrb.org, mustafa@icddrb.org, and tahmeed@icddrb.org. Esto Mduma, Haydom Global Health Institute, Haydom, Tanzania, E-mail: estomduma@gmail.com.

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