Relationship between growth and illness, enteropathogens and dietary intakes in the first 2 years of life: Findings from the MAL-ED birth cohort study

MAL-ED Network Investigators

Research output: Contribution to journalArticle

Abstract

Background Dietary and illness factors affect risk of growth faltering; the role of enteropathogens is less clear. As part of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, we quantify the effects of enteropathogen infection, diarrhoea and diet on child growth. Methods Newborns were enrolled and followed until 24 months. Length and weight were assessed monthly. Illnesses and breastfeeding practices were documented biweekly; from 9 to 24 months, non-breast milk intakes were quantified monthly. Routinely collected non-diarrhoeal stools were analysed for a broad array of enteropathogens. A linear piecewise spline model was used to quantify associations of each factor with growth velocity in seven of eight MAL-ED sites; cumulative effects on attained size at 24 months were estimated for mean, low (10th percentile) and high (90th percentile) exposure levels. Additionally, the six most prevalent enteropathogens were evaluated for their effects on growth. results Diarrhoea did not have a statistically significant effect on growth. Children with high enteropathogen exposure were estimated to be 1.21±0.33 cm (p<0.001; 0.39 length for age (LAZ)) shorter and 0.08±0.15 kg (p=0.60; 0.08 weight-for-age (WAZ)) lighter at 24 months, on average, than children with low exposure. Campylobacter and enteroaggregativeEscherichia coli detections were associated with deficits of 0.83±0.33 and 0.85±0.31 cm in length (p=0.011 and 0.001) and 0.22±0.15 and 0.09±0.14 kg in weight (p=0.14 and 0.52), respectively. Children with low energy intakes and protein density were estimated to be 1.39±0.33 cm (p<0.001; 0.42 LAZ) shorter and 0.81±0.15 kg (p<0.001; 0.65 WAZ) lighter at 24 months than those with high intakes. conclusions Reducing enteropathogen burden and improving energy and protein density of complementary foods could reduce stunting.

Original languageEnglish (US)
Article numbere000370
JournalBMJ Global Health
Volume2
Issue number4
DOIs
StatePublished - Jan 1 2017

Fingerprint

Cohort Studies
Parturition
Growth
Weights and Measures
Diarrhea
Campylobacter coli
Growth Disorders
Child Development
Infection
Energy Intake
Breast Feeding
Malnutrition
Intercellular Signaling Peptides and Proteins
Milk
Proteins
Newborn Infant
Diet
Food

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Relationship between growth and illness, enteropathogens and dietary intakes in the first 2 years of life : Findings from the MAL-ED birth cohort study. / MAL-ED Network Investigators.

In: BMJ Global Health, Vol. 2, No. 4, e000370, 01.01.2017.

Research output: Contribution to journalArticle

@article{69633fb6bace44edaff2e82870dbbab4,
title = "Relationship between growth and illness, enteropathogens and dietary intakes in the first 2 years of life: Findings from the MAL-ED birth cohort study",
abstract = "Background Dietary and illness factors affect risk of growth faltering; the role of enteropathogens is less clear. As part of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, we quantify the effects of enteropathogen infection, diarrhoea and diet on child growth. Methods Newborns were enrolled and followed until 24 months. Length and weight were assessed monthly. Illnesses and breastfeeding practices were documented biweekly; from 9 to 24 months, non-breast milk intakes were quantified monthly. Routinely collected non-diarrhoeal stools were analysed for a broad array of enteropathogens. A linear piecewise spline model was used to quantify associations of each factor with growth velocity in seven of eight MAL-ED sites; cumulative effects on attained size at 24 months were estimated for mean, low (10th percentile) and high (90th percentile) exposure levels. Additionally, the six most prevalent enteropathogens were evaluated for their effects on growth. results Diarrhoea did not have a statistically significant effect on growth. Children with high enteropathogen exposure were estimated to be 1.21±0.33 cm (p<0.001; 0.39 length for age (LAZ)) shorter and 0.08±0.15 kg (p=0.60; 0.08 weight-for-age (WAZ)) lighter at 24 months, on average, than children with low exposure. Campylobacter and enteroaggregativeEscherichia coli detections were associated with deficits of 0.83±0.33 and 0.85±0.31 cm in length (p=0.011 and 0.001) and 0.22±0.15 and 0.09±0.14 kg in weight (p=0.14 and 0.52), respectively. Children with low energy intakes and protein density were estimated to be 1.39±0.33 cm (p<0.001; 0.42 LAZ) shorter and 0.81±0.15 kg (p<0.001; 0.65 WAZ) lighter at 24 months than those with high intakes. conclusions Reducing enteropathogen burden and improving energy and protein density of complementary foods could reduce stunting.",
author = "{MAL-ED Network Investigators} and Acosta, {Angel Mendez} and {De Burga}, {Rosa Rios} and Chavez, {Cesar Banda} and Flores, {Julian Torres} and Olotegui, {Maribel Paredes} and Pinedo, {Silvia Rengifo} and Salas, {Mery Siguas} and Trigoso, {Dixner Rengifo} and Vasquez, {Angel Orbe} and Imran Ahmed and Didar Alam and Asad Ali and Bhutta, {Zulfiqar A.} and Shahida Qureshi and Muneera Rasheed and Sajid Soofi and Ali Turab and Zaidi, {Anita K.M.} and Ladaporn Bodhidatta and Mason, {Carl J.} and Sudhir Babji and Anuradha Bose and George, {Ajila T.} and Dinesh Hariraju and {Steffi Jennifer}, M. and Sushil John and Shiny Kaki and Gagandeep Kang and Priyadarshani Karunakaran and Beena Koshy and Lazarus, {Robin P.} and Jayaprakash Muliyil and Raghava, {Mohan Venkata} and Sophy Raju and Anup Ramachandran and Rakhi Ramadas and Karthikeyan Ramanujam and Anuradha Bose and Reeba Roshan and Sharma, {Srujan L.} and {Shanmuga Sundaram}, E. and Thomas, {Rahul J.} and Pan, {William K.} and Ramya Ambikapathi and Monica McGrath and Black, {Robert E} and Laura Caulfield and William Checkley and Margaret Kosek and Schulze, {Kerry J}",
year = "2017",
month = "1",
day = "1",
doi = "10.1136/bmjgh-2017-000370",
language = "English (US)",
volume = "2",
journal = "BMJ Global Health",
issn = "2059-7908",
publisher = "BMJ Publishing Group",
number = "4",

}

TY - JOUR

T1 - Relationship between growth and illness, enteropathogens and dietary intakes in the first 2 years of life

T2 - Findings from the MAL-ED birth cohort study

AU - MAL-ED Network Investigators

AU - Acosta, Angel Mendez

AU - De Burga, Rosa Rios

AU - Chavez, Cesar Banda

AU - Flores, Julian Torres

AU - Olotegui, Maribel Paredes

AU - Pinedo, Silvia Rengifo

AU - Salas, Mery Siguas

AU - Trigoso, Dixner Rengifo

AU - Vasquez, Angel Orbe

AU - Ahmed, Imran

AU - Alam, Didar

AU - Ali, Asad

AU - Bhutta, Zulfiqar A.

AU - Qureshi, Shahida

AU - Rasheed, Muneera

AU - Soofi, Sajid

AU - Turab, Ali

AU - Zaidi, Anita K.M.

AU - Bodhidatta, Ladaporn

AU - Mason, Carl J.

AU - Babji, Sudhir

AU - Bose, Anuradha

AU - George, Ajila T.

AU - Hariraju, Dinesh

AU - Steffi Jennifer, M.

AU - John, Sushil

AU - Kaki, Shiny

AU - Kang, Gagandeep

AU - Karunakaran, Priyadarshani

AU - Koshy, Beena

AU - Lazarus, Robin P.

AU - Muliyil, Jayaprakash

AU - Raghava, Mohan Venkata

AU - Raju, Sophy

AU - Ramachandran, Anup

AU - Ramadas, Rakhi

AU - Ramanujam, Karthikeyan

AU - Bose, Anuradha

AU - Roshan, Reeba

AU - Sharma, Srujan L.

AU - Shanmuga Sundaram, E.

AU - Thomas, Rahul J.

AU - Pan, William K.

AU - Ambikapathi, Ramya

AU - McGrath, Monica

AU - Black, Robert E

AU - Caulfield, Laura

AU - Checkley, William

AU - Kosek, Margaret

AU - Schulze, Kerry J

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background Dietary and illness factors affect risk of growth faltering; the role of enteropathogens is less clear. As part of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, we quantify the effects of enteropathogen infection, diarrhoea and diet on child growth. Methods Newborns were enrolled and followed until 24 months. Length and weight were assessed monthly. Illnesses and breastfeeding practices were documented biweekly; from 9 to 24 months, non-breast milk intakes were quantified monthly. Routinely collected non-diarrhoeal stools were analysed for a broad array of enteropathogens. A linear piecewise spline model was used to quantify associations of each factor with growth velocity in seven of eight MAL-ED sites; cumulative effects on attained size at 24 months were estimated for mean, low (10th percentile) and high (90th percentile) exposure levels. Additionally, the six most prevalent enteropathogens were evaluated for their effects on growth. results Diarrhoea did not have a statistically significant effect on growth. Children with high enteropathogen exposure were estimated to be 1.21±0.33 cm (p<0.001; 0.39 length for age (LAZ)) shorter and 0.08±0.15 kg (p=0.60; 0.08 weight-for-age (WAZ)) lighter at 24 months, on average, than children with low exposure. Campylobacter and enteroaggregativeEscherichia coli detections were associated with deficits of 0.83±0.33 and 0.85±0.31 cm in length (p=0.011 and 0.001) and 0.22±0.15 and 0.09±0.14 kg in weight (p=0.14 and 0.52), respectively. Children with low energy intakes and protein density were estimated to be 1.39±0.33 cm (p<0.001; 0.42 LAZ) shorter and 0.81±0.15 kg (p<0.001; 0.65 WAZ) lighter at 24 months than those with high intakes. conclusions Reducing enteropathogen burden and improving energy and protein density of complementary foods could reduce stunting.

AB - Background Dietary and illness factors affect risk of growth faltering; the role of enteropathogens is less clear. As part of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, we quantify the effects of enteropathogen infection, diarrhoea and diet on child growth. Methods Newborns were enrolled and followed until 24 months. Length and weight were assessed monthly. Illnesses and breastfeeding practices were documented biweekly; from 9 to 24 months, non-breast milk intakes were quantified monthly. Routinely collected non-diarrhoeal stools were analysed for a broad array of enteropathogens. A linear piecewise spline model was used to quantify associations of each factor with growth velocity in seven of eight MAL-ED sites; cumulative effects on attained size at 24 months were estimated for mean, low (10th percentile) and high (90th percentile) exposure levels. Additionally, the six most prevalent enteropathogens were evaluated for their effects on growth. results Diarrhoea did not have a statistically significant effect on growth. Children with high enteropathogen exposure were estimated to be 1.21±0.33 cm (p<0.001; 0.39 length for age (LAZ)) shorter and 0.08±0.15 kg (p=0.60; 0.08 weight-for-age (WAZ)) lighter at 24 months, on average, than children with low exposure. Campylobacter and enteroaggregativeEscherichia coli detections were associated with deficits of 0.83±0.33 and 0.85±0.31 cm in length (p=0.011 and 0.001) and 0.22±0.15 and 0.09±0.14 kg in weight (p=0.14 and 0.52), respectively. Children with low energy intakes and protein density were estimated to be 1.39±0.33 cm (p<0.001; 0.42 LAZ) shorter and 0.81±0.15 kg (p<0.001; 0.65 WAZ) lighter at 24 months than those with high intakes. conclusions Reducing enteropathogen burden and improving energy and protein density of complementary foods could reduce stunting.

UR - http://www.scopus.com/inward/record.url?scp=85055284665&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055284665&partnerID=8YFLogxK

U2 - 10.1136/bmjgh-2017-000370

DO - 10.1136/bmjgh-2017-000370

M3 - Article

AN - SCOPUS:85055284665

VL - 2

JO - BMJ Global Health

JF - BMJ Global Health

SN - 2059-7908

IS - 4

M1 - e000370

ER -