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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
Open accessAbstract
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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“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]
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“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.”
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Metadata
- 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)
- 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
- gold
- doi.org
- 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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