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Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study

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Alam, Md Ashraful, Richard, Stephanie A., Fahim, Shah Mohammad, Mahfuz, Mustafa, Nahar, Baitun, Das, Subhasish, Shrestha, Binod, Koshy, Beena +5 more·2020·PLoS ONE
DOI 10.1371/journal.pone.0227839PMC PMC7032711
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Abstract

BACKGROUND: Globally more than 150 million children under age 5 years were stunted in 2018, primarily in low- and middle-income countries (LMICs), and the impact of early-onset, persistent stunting has not been well explored. To explore the association between early-onset persistent stunting in children and cognitive development at 5 years of age, and to identify the factors associated with early-onset stunting. METHODS AND FINDINGS: Children from the MAL-ED cohort study were followed from birth to 5 years of age in six LMICs. The Wechsler Preschool Primary Scales of Intelligence (WPPSI) was used to assess cognitive abilities (fluid reasoning) at 5 years and was adapted for each culture. Stunting was categorized as early-onset persistent (first stunted at 1-6 months and persisting at 60 months), early-onset recovered (first stunted at 1-6 months and not stunted at 60 months), late-onset persistent (first stunted at 7-24 months and persisting at 60 months), late-onset recovered (first stunted at 7-24 months and not stunted at 60 months), and never (never stunted). Mixed effects linear models were used to estimate the relationship between stunting status and cognitive development. Children with early-onset persistent stunting had significantly lower cognitive scores (-2.10 (95% CI: -3.85, -0.35)) compared with those who were never stunted. Transferrin receptor (TfR) was also negatively associated with cognitive development (-0.31 (95% CI: -0.49, -0.13)), while the HOME inventory, an index of quality of the home environment (0.46 (95% CI: 0.21, 0.72)) and socio-economic status (1.50 (95% CI: 1.03, 1.98)) were positively associated with cognitive development. CONCLUSIONS: Early-onset persistent stunting was associated with lower cognitive development in children at 5 years of age in this cohort of children.

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  • A cohort study in 8 Low-Middle Income Countries demonstrated that stunting within the first 6 months which persisted for 60 months was associated with lower cognitive development in children at 5 years old.

    “while a cohort study in 8 Low-Middle Income Countries including those in Africa demonstrated that stunting within the first 6 months which persisted for 60 months was associated with lower cognitive development in children at 5 years old [36].”

    From Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using the Griffiths Scales of Child Development (2021) · cites this paper as [36]

    The Abstract (Methods and findings) reports that children first stunted at 1–6 months and still stunted at 60 months had significantly lower cognitive scores at age five than never-stunted children. But the analysis covered six low- and middle-income countries, not eight. The Methods (Study setting and participants) explain that the broader MAL-ED cohort had eight sites, including sites in South Africa and Tanzania, but two sites were excluded from this analysis. (LLM, conf=0.94)

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  • Hunger and poor nutrition contribute to stunting and several studies have shown a link between stunting and poor child development in low- and middle-income countries.

    “Hunger and poor nutrition contribute to stunting and several studies [35,36] have shown a link between stunting and poor child development in low- and middle-income countries.”

    From Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using the Griffiths Scales of Child Development (2021) · cites this paper as [36]

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Research works printed but not linked: 2

  1. [25]25. Investigators M-EN. The malnutrition and enteric disease study (MAL-ED): understanding the consequences for child health and development. Clin Infect Dis. 2014; 59:S193Á330.
  2. [38]38. Wechsler D. The Weschler Preschool and Primary Scales of Intelligence-III—Third Edition (WPPSI–III). San Antonio, TX: Psychological Corporation 2002.

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Authors
Alam, M. A., Richard, S. A., Fahim, S. M., Mahfuz, M., Nahar, B., Das, S., Shrestha, B., Koshy, B., Mduma, E., Seidman, J. C., Murray-Kolb, L. E., Caulfield, L. E., & Ahmed, T.
Affiliations
  • International Centre for Diarrhoeal Disease Research (BD)
  • National Institutes of Health (US)
  • Christian Medical College, Vellore (IN)
  • Haydom Lutheran Hospital (TZ)
  • Johns Hopkins University (US)
Corresponding author
  • Alam, Md Ashraful
  • Richard, Stephanie A.
  • Fahim, Shah Mohammad
  • Mahfuz, Mustafa
  • Nahar, Baitun
  • Das, Subhasish
  • Shrestha, Binod
  • Koshy, Beena
  • Mduma, Estomih
  • Seidman, Jessica C.
  • Caulfield, Laura E.
  • Ahmed, Tahmeed
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2020-01-24
Volume
15
Issue
1
Pages
e0227839
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0227839
PMC
PMC7032711
OpenAlex
W3003135612
Cited by
150
References
77
Citations by year
2026: 11 · 2025: 21 · 2024: 19 · 2023: 32 · 2022: 46 · 2021: 16 · 2020: 5
FWCI
15.95
Type
journal article
Language
en
Update notices
correction (2020-02-20)
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • ResearchSpace (University of Auckland) (submittedVersion, cc-by)
  • Greater South Information System
Funders
Bill and Melinda Gates Foundation
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 › Hematology › Iron Metabolism and Disorders
Keywords
cognitive development, fluid reasoning, preschool children, transferrin receptor, family environment, socioeconomic status, low- and middle-income countries, child malnutrition
MeSH terms
Birth Weight, Breast Feeding, Child, Child, Preschool, Cognition, Female, Growth Disorders, Humans, Infant, Inflammation, Intelligence Tests, Male, Poverty, Sanitation, Social Class, Cohort Studies, Linear Models, Cognitive Dysfunction

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