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Cited by 130Child Nutrition and Water AccessPublic Health and NutritionBirth, Development, and Health

Causes and consequences of child growth faltering in low-resource settings

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Mertens, Andrew, Benjamin-Chung, Jade, Colford, John M., Coyle, Jeremy, van der Laan, Mark J., Hubbard, Alan E., Rosete, Sonali, Malenica, Ivana +100 more·2023·Nature
DOI 10.1038/s41586-023-06501-xPMC PMC10511328
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Abstract

. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.

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  • Critical public health improvements such as in water, sanitation, and hygiene might have contributed to decreases in enteric deaths.

    “Alongside the provision of oral rehydration solution and rotavirus vaccines, critical public health improvements such as in water, sanitation, and hygiene might have contributed to decreases in enteric deaths.35, 36”

    From Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [36]

    The Main section says water, sanitation and hygiene interventions aim to reduce childhood infections, but does not link them to declining enteric deaths. The ‘Consequences of early growth faltering’ section reports all-cause mortality and says the data lack cause-specific mortality; searches for enteric deaths and diarrhoeal mortality found no passage supporting the claimed contribution. (LLM, conf=0.76)

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Authors
Mertens, A., Benjamin-Chung, J., Colford, J. M., Coyle, J., van der Laan, M. J., Hubbard, A. E., Rosete, S., Malenica, I., Hejazi, N., Sofrygin, O., Cai, W., Li, H., Nguyen, A., Pokpongkiat, N. N., Djajadi, S., Seth, A., Jung, E., Chung, E. O., Jilek, W., Subramoney, V., Hafen, R., Häggström, J., Norman, T., Brown, K. H., Christian, P., Arnold, B. F., The Ki Child Growth Consortium, Abbeddou, S., Adair, L. S., Ahmed, T., Ali, A., Ali, H., Ashorn, P., Bahl, R., Barreto, M. L., Becquey, E., Begín, F., Bessong, P. O., Bhan, M. K., Bhandari, N., Bhargava, S. K., Bhutta, Z. A., Black, R. E., Bodhidatta, L., Carba, D., Checkley, W., Christian, P., Crabtree, J. E., Dewey, K. G., Duggan, C. P., Fall, C. H. D., Faruque, A. S. G., Fawzi, W. W., da Silva Filho, J. Q., Gilman, R. H., Guerrant, R. L., Haque, R., Hasan, S. M. T., Hess, S. Y., Houpt, E. R., Humphrey, J. H., Iqbal, N. T., Jimenez, E. Y., John, J., John, S. M., Kang, G., Kosek, M., Kramer, M. S., Labrique, A., Lee, N. R., Lima, A. Â. M., Mahopo, T. C., Maleta, K., Manandhar, D. S., Manji, K. P., Martorell, R., Mazumder, S., Mduma, E., Mohan, V. R., Moore, S. E., Ntozini, R., Nyathi, M. E., Olortegui, M. P., Ouédraogo, C. T., Petri, W. A., Premkumar, P. S., Prentice, A. M., Rahman, N., Ramirez-Zea, M., Sachdev, H. S., Sadiq, K., Sarkar, R., Sarmin, M., Saville, N. M., Shaikh, S., Shrestha, B. P., Shrestha, S. K., Soares, A. M., Sonko, B., Stein, A. D., Svensen, E., Syed, S., Umrani, F., Ward, H. D., West, K. P., Wu, L. S. F., Yang, S., & Yori, P. P.
Affiliations
  • University of California, Berkeley (US)
  • Cytel (United States) (US)
  • Gates Foundation (US)
  • University of California, Davis (US)
  • University of California, San Francisco (US)
  • Ghent University (BE)
  • University of North Carolina at Chapel Hill (US)
  • International Centre for Diarrhoeal Disease Research (BD)
  • Aga Khan University (PK)
  • Johns Hopkins University (US)
  • Tampere University (FI)
  • World Health Organization (CH)
  • International Food Policy Research Institute (US)
  • University of Venda (ZA)
  • Indian Institute of Technology Delhi (IN)
  • Society for Applied Studies (IN)
  • Sunder Lal Jain Hospital (IN)
  • Armed Forces Research Institute of Medical Science (TH)
  • University of San Carlos (PH)
  • University of Leeds (GB)
  • University of California, Los Angeles (US)
  • Boston Children's Hospital (US)
  • University of Southampton (GB)
  • Harvard University (US)
  • University of Virginia (US)
  • Universidade Federal do Ceará (BR)
  • University of New Mexico Health Sciences Center (US)
  • Christian Medical College, Vellore (IN)
  • Translational Health Science and Technology Institute (IN)
  • McGill University Health Centre (CA)
  • University of Malawi (MW)
  • Mother and Infant Research Activities (NP)
  • Muhimbili University of Health and Allied Sciences (TZ)
  • Emory University (US)
  • Haydom Lutheran Hospital (TZ)
  • King's College London (GB)
  • Zvitambo Institute for Maternal and Child Health Research (ZW)
  • MRC Unit the Gambia (GM)
  • Sitaram Bhartia Institute of Science and Research (IN)
  • University College London (GB)
  • University of Bergen (NO)
  • Haukeland University Hospital (NO)
  • Tufts University (US)
  • McGill University (CA)
Corresponding author
  • Mertens, Andrew
  • Arnold, Benjamin F.
ORCID
Venue
Nature
Publisher
Springer Science and Business Media LLC
Published
2023-09-13
Volume
621
Issue
7979
Pages
568-576
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
DOI
10.1038/s41586-023-06501-x
PMC
PMC10511328
OpenAlex
W4386697793
Cited by
130
References
138
Citations by year
2026: 44 · 2025: 43 · 2024: 37 · 2023: 6
FWCI
22.82
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • IFPRI E-brary (International Food Policy Research Institute) (submittedVersion, other-oa)
  • CGSPace A Repository of Agricultural Research Outputs (Consultative Group for International Agricultural Research) (submittedVersion, other-oa)
  • International Food Policy Research Institute (International Food Policy Research Institute) (submittedVersion, other-oa)
  • UCL Discovery (University College London) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • Greater South Information System
Funders
  • Medical Research Council (MR/P012019/1, MC_PC_21037, MC_UU_12011/3)
  • National Heart, Lung, and Blood Institute (T32HL151323)
  • National Institute of Allergy and Infectious Diseases (K01AI141616)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K23DK117061)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
child growth faltering, stunting, wasting, resource-limited settings, maternal anthropometry, birth weight, prenatal nutrition, postnatal growth, child mortality, length-for-age z-score, weight-for-length z-score
MeSH terms
Anthropometry, Cachexia, Child, Preschool, Developing Countries, Female, Growth Disorders, Humans, Infant, Infant, Newborn, Longitudinal Studies, Male, Mothers, Pregnancy, Sex Factors, Cohort Studies, Dietary Supplements, Malnutrition

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