Role of maternal health and infant inflammation in nutritional and neurodevelopmental outcomes of two-year-old Bangladeshi children

Donowitz, Jeffrey R.; Cook, Heather; Alam, Masud; Tofail, Fahmida; Kabir, Mamun; Colgate, E. Ross; Carmolli, Marya P.; Kirkpatrick, Beth D.; Nelson, Charles A.; Jennie, Z.; Petri, William A.

doi:10.1371/journal.pntd.0006363

Cited by 31 publications

(35 citation statements)

References 77 publications

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“…All reported a significant positive relationship between underweight mothers and poor linear growth of children ( Figure 3). Donowitz et al (2018) 2019, and Svefors (2018). The mothers with short height (<145 cm) had 4.7 times (95% CI: 2.28-9.56) higher chance of having a stunted child compared to mothers with higher height (Hasan et al, 2019).…”

Section: Maternal Factorsmentioning

confidence: 99%

“…In total, eight studies investigated the influence of mother's nutrition on stunting among children aged 0-23 months in Bangladesh (Ahmed, Ahmed, Roy, Alam, & Hossain, 2012;Alam et al, 2017;Choudhury et al, 2017;Donowitz et al, 2018;Khan et al, 2017;Kim, Mejía-Guevara, Corsi, Aguayo, & Subramanian, 2017;Mistry et al, 2019;Mondal et al, 2011). All reported a significant positive relationship between underweight mothers and poor linear growth of children ( Figure 3).…”

Section: Maternal Factorsmentioning

confidence: 99%

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Determinants of stunting during the first 1,000 days of life in Bangladesh: A review

Islam

Ullah

Mainali³

et al. 2020

Food Science & Nutrition

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Stunting is a major problem in Bangladesh, with a prevalence of 31% in 2017. The prevalence of stunting in children aged under two has reduced by only 6% since 2004. After children reach 2 years of age, the consequences of stunting become almost irreversible. This paper seeks to examine and analyze the determinants associated with stunting during the first 1,000 days of life in Bangladesh to assist in developing evidence‐based interventions in Bangladesh. A literature review was conducted comprehensively on all relevant peer‐reviewed and gray literature of studies conducted in Bangladesh. The existing literature was searched and examined using the World Health Organization (WHO) conceptual framework for stunting. Evidence indicates that low maternal weight, lack of maternal education, severe food insecurity, lack of access to suitable nutrition, nonexclusive breastfeeding, pathogen‐specific diarrhea, and low weight and height at birth are associated with early childhood stunting in Bangladesh. The relation of the quality of drinking water with stunting is not clear in Bangladesh. Literature about the association between stunting and determinants such as the political economy, education systems, and agriculture and food systems is not found. This synthesis shows that the factors of stunting are multifaceted. As such, a multi‐sectoral approach is essential in Bangladesh, employing evidence‐based interventions to address the determinants that contribute to the risk of stunting to achieve the global nutrition target by 2025.

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Section: Maternal Factorsmentioning

confidence: 99%

Section: Maternal Factorsmentioning

confidence: 99%

Determinants of stunting during the first 1,000 days of life in Bangladesh: A review

Islam

Ullah

Mainali³

et al. 2020

Food Science & Nutrition

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“…This could explain the link between GHBT positivity and the enteric inflammation and epithelial cell damage that hallmark EED, which we showed in our previous analysis of this cohort [6]. EED is a significant cause of morbidity in the low-income pediatric population and has been associated with failure of oral vaccines, neurodevelopmental delays, and growth stunting [11, 27–29]. Furthermore, GHBT positivity was directly associated with prior linear growth stunting in this cohort [6].…”

Section: Discussionmentioning

confidence: 55%

Increased Fecal Lactobacillus Is Associated With a Positive Glucose Hydrogen Breath Test in Bangladeshi Children

Donowitz

Parikh

Taniuchi

et al. 2019

Open Forum Infectious Diseases

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Background Glucose hydrogen breath testing is a noninvasive test for small intestine bacterial overgrowth (SIBO). A positive glucose hydrogen breath test is common in children from low-income countries and has been found to be associated with malnutrition as measured by stunted growth. The microbiome associated with positive breath testing is relatively unstudied. Methods We performed 16 S V4 rDNA microbiome analysis on the stool of 90 Bangladeshi children aged 2 years from an impoverished neighborhood who were tested at the same time for SIBO by glucose hydrogen breath testing. Data were analyzed by linear discriminant analysis effect size with SIBO as the outcome. Any selected genera were tested individually by Wilcoxon’s rank-sum test to ensure that linear discriminant analysis effect size results were not outlier-skewed. Results Linear discriminant analysis effect size analysis identified Lactobacillus (linear discriminate analysis score, 4.59; P = .03) as over-represented in 15 out of the 90 children who were SIBO positive. Conclusions These results suggest that glucose hydrogen breath test positivity in children from low-income settings may be due to an upper intestinal Lactobacillus bloom, potentially explaining the association of SIBO with the gut damage and inflammation that leads to malnutrition.

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“…HAZ at birth was shown to be a significantly strong predictor of growth followed by CRP, AGP, and IL1. Much emphasis has been placed on stunting status at birth and overall prenatal helth affecting clinical outcomes in previously published studies including stunting later on in life and poor neurodevelopmental outcomes [ 19 – 21 ]. Such findings highlight the importance of interventions in the early months of life to prevent subsequent stunting and its consequences [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Machine learning model demonstrates stunting at birth and systemic inflammatory biomarkers as predictors of subsequent infant growth – a four-year prospective study

et al. 2020

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Background Stunting affects up to one-third of the children in low-to-middle income countries (LMICs) and has been correlated with decline in cognitive capacity and vaccine immunogenicity. Early identification of infants at risk is critical for early intervention and prevention of morbidity. The aim of this study was to investigate patterns of growth in infants up through 48 months of age to assess whether the growth of infants with stunting eventually improved as well as the potential predictors of growth. Methods Height-for-age z-scores (HAZ) of children from Matiari (rural site, Pakistan) at birth, 18 months, and 48 months were obtained. Results of serum-based biomarkers collected at 6 and 9 months were recorded. A descriptive analysis of the population was followed by assessment of growth predictors via traditional machine learning random forest models. Results Of the 107 children who were followed up till 48 months of age, 51% were stunted (HAZ < − 2) at birth which increased to 54% by 48 months of age. Stunting status for the majority of children at 48 months was found to be the same as at 18 months. Most children with large gains started off stunted or severely stunted, while all of those with notably large losses were not stunted at birth. Random forest models identified HAZ at birth as the most important feature in predicting HAZ at 18 months. Of the biomarkers, AGP (Alpha- 1-acid Glycoprotein), CRP (C-Reactive Protein), and IL1 (interleukin-1) were identified as strong subsequent growth predictors across both the classification and regressor models. Conclusion We demonstrated that children most children with stunting at birth remained stunted at 48 months of age. Value was added for predicting growth outcomes with the use of traditional machine learning random forest models. HAZ at birth was found to be a strong predictor of subsequent growth in infants up through 48 months of age. Biomarkers of systemic inflammation, AGP, CRP, IL1, were also strong predictors of growth outcomes. These findings provide support for continued focus on interventions prenatally, at birth, and early infancy in children at risk for stunting who live in resource-constrained regions of the world.

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Role of maternal health and infant inflammation in nutritional and neurodevelopmental outcomes of two-year-old Bangladeshi children

Cited by 31 publications

References 77 publications

Determinants of stunting during the first 1,000 days of life in Bangladesh: A review

Determinants of stunting during the first 1,000 days of life in Bangladesh: A review

Increased Fecal Lactobacillus Is Associated With a Positive Glucose Hydrogen Breath Test in Bangladeshi Children

Machine learning model demonstrates stunting at birth and systemic inflammatory biomarkers as predictors of subsequent infant growth – a four-year prospective study

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