Date post: | 20-Feb-2017 |
Category: |
Healthcare |
Upload: | core-group |
View: | 332 times |
Download: | 0 times |
Factors Associated with Growth
in the First 1000 Days
William Checkley, MD, PhD
Johns Hopkins University
October 8, 2015
Disclosures
• Funding by the Bill & Melinda Gates
Foundation
• No conflicts of interest to disclose
Public health significance
• Malnutrition is a leading cause of mortality
and morbidity in developing countries.
• Stunting, severe wasting, and IUGR are
responsible for 2.2 million child deaths.
• 178 million children under five in developing
countries are stunted.
Black RE et al. Lancet 2008;371:243-60.
Severe, acute malnutrition increases the risk of death ...
Fishman et al. In Comparative quantification of health risks. WHO 2004.
… but height faltering as a result of infection is more prevalent
Boys (n = 128) Girls (n = 96)
Age (months)
He
igh
t (c
m)
WHO standard
0 10 20 30
50
60
70
80
90
0 10 20 30
Once stunted, it is hard to recover
Checkley et al. Int J Epidemiol 2008
Once stunted, it is hard to recover
Moore et al. Int J Epidemiol 2001
Childhood stunting has adverse consequences on cognition
Berkman et al. Lancet 2002
Longitudinal relationship between wasting and stunting in childhood
• The relationship between stunting and
wasting is unclear.
• Ecologic analyses suggest there is little
correlation.
• Limited information between wasting and
stunting at the individual level.
Walker SP et al. Acta Paediatr 1996
Childhood Malnutrition and Infection Network
• Eight cohort studies
• Anthropometry measurements every 1 to 4
months in the first 24 months of life
• 27,117 anthropometric measurements for
1,604 children
Cumulative incidence
Cross-sectional relationship at different ages
History of wasting and stunting
R=0.94, P<0.001
Length-for-age as a function of wasting
SD=0.5
SD=1
SD=0.25 SD=0.75
SD=2 SD=3
Weight-for-length variability
Weight-for-length variability
Length-for-age (95 % CI)
WLZ variability in first 18 months (> 0.5 SDs)
-0.51 (-0.67 to -0.36)
Odds of stunting (95% CI)
WLZ variability in first 18 months (> 0.5 SDs)
2.51 (1.23 to 5.09)
Conclusions
• Interventions to reduce wasting in early
childhood may have improve linear growth
• Instances of wasting may not be the primary
cause of stunting
Conclusions
• Interventions to reduce wasting in early
childhood may have improve linear growth
• Instances of wasting may not be the primary
cause of stunting
Acknowledgements
• Child Malnutrition and Infection Network
investigators
• MAL-ED Network investigators