Early childhood undernutrition increases risk of hearing loss in young adulthood in rural Nepal

Susan D. Emmett, Jane Schmitz, Sureswor L. Karna, Subarna K. Khatry, Lee Wu, Steven C. LeClerq, Joseph Pillion, Keith P. West

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Prevalence of young adult hearing loss is high in lowresource societies; the reasons for this are likely complex but could involve early childhood undernutrition. Objective:We evaluated preschool childhood stunting, wasting, and underweight as risk factors for hearing loss in young adulthood in Sarlahi District, southern Nepal. Design: Ear health was assessed in 2006-2008 in a cohort of 2193 subjects aged 16-23 y, who as children <60 mo of age participated in a 16-mo placebo-controlled, randomized Vitamin A supplementation trial from 1989 to 1991. At each of five 4-mo assessments, field staff measured children™s weight, height, and mid-upper arm circumference (MUAC) and recorded validated parental history of ear discharge in the previous 7 d. Children were classified as stunted [<-2 z score height-for-age (HAZ)], underweight [<-2 z score weightfor- age (WAZ)], or wasted [<-2 z scoreMUAC-for-age (MUACAZ) or body mass index-for-age (BMIAZ)]. At follow-up, hearing was tested by audiometry and tympanometry, with hearing loss defined as pure-tone average >30dB in the worse ear (0.5, 1, 2, 4 kHz) and middle-ear dysfunction as abnormal tympanometric peak height (<0.3 or >1.4 mmho) or width (<50 or >110 daPa). Results: Hearing loss, present in 5.9% (95% CI: 5.01%, 7.00%) of subjects, was associated with early childhood stunting (OR: 1.64; 95% CI: 1.10, 1.45), underweight (OR: 1.70; 95% CI: 1.18, 2.44) and wasting by BMIAZ (OR: 1.88; 95% CI: 1.19, 2.97) and MUACAZ (OR: 2.14; 95% CI: 1.47, 3.12). Abnormal tympanometry, affecting 16.6% (95% CI: 15.06%, 18.18%), was associated with underweight (OR: 1.46; 95% CI: 1.16, 1.84) and wasting by BMIAZ (OR: 1.80; 95% CI: 1.32, 2.46) and MUACAZ (OR: 1.42; 95% CI: 1.10, 1.84), but not stunting (OR: 1.18; 95% CI: 0.93, 1.49) in early childhood. Highest ORs were observed for subjects with both hearing loss and abnormal tympanometry, ranging from 1.87 to 2.24 (all lower 95% CI >1.00). Conclusions: Early childhood undernutrition is a modifiable risk factor for early adulthood hearing loss.

Original languageEnglish (US)
Pages (from-to)268-277
Number of pages10
JournalAmerican Journal of Clinical Nutrition
Issue number2
StatePublished - Feb 2018
Externally publishedYes


  • Hearing loss
  • Low-resource settings
  • Nepal
  • Nutrition
  • Stunting
  • Undernutrition
  • Wasting

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


Dive into the research topics of 'Early childhood undernutrition increases risk of hearing loss in young adulthood in rural Nepal'. Together they form a unique fingerprint.

Cite this