factors associated with growth in the first 1,000 days checkley
TRANSCRIPT
Factors Associated with Growth
in the First 1000 Days
William Checkley, MD, PhD
Johns Hopkins University
October 8, 2015
Disclosures
• Funding by the Bill & Melinda Gates
Foundation
• No conflicts of interest to disclose
Public health significance
• Malnutrition is a leading cause of mortality
and morbidity in developing countries.
• Stunting, severe wasting, and IUGR are
responsible for 2.2 million child deaths.
• 178 million children under five in developing
countries are stunted.
Black RE et al. Lancet 2008;371:243-60.
Severe, acute malnutrition increases the risk of death ...
Fishman et al. In Comparative quantification of health risks. WHO 2004.
… but height faltering as a result of infection is more prevalent
Boys (n = 128) Girls (n = 96)
Age (months)
He
igh
t (c
m)
WHO standard
0 10 20 30
50
60
70
80
90
0 10 20 30
Once stunted, it is hard to recover
Checkley et al. Int J Epidemiol 2008
Once stunted, it is hard to recover
Moore et al. Int J Epidemiol 2001
Childhood stunting has adverse consequences on cognition
Berkman et al. Lancet 2002
Longitudinal relationship between wasting and stunting in childhood
• The relationship between stunting and
wasting is unclear.
• Ecologic analyses suggest there is little
correlation.
• Limited information between wasting and
stunting at the individual level.
Walker SP et al. Acta Paediatr 1996
Childhood Malnutrition and Infection Network
• Eight cohort studies
• Anthropometry measurements every 1 to 4
months in the first 24 months of life
• 27,117 anthropometric measurements for
1,604 children
Cumulative incidence
Cross-sectional relationship at different ages
History of wasting and stunting
R=0.94, P<0.001
Length-for-age as a function of wasting
SD=0.5
SD=1
SD=0.25 SD=0.75
SD=2 SD=3
Weight-for-length variability
Weight-for-length variability
Length-for-age (95 % CI)
WLZ variability in first 18 months (> 0.5 SDs)
-0.51 (-0.67 to -0.36)
Odds of stunting (95% CI)
WLZ variability in first 18 months (> 0.5 SDs)
2.51 (1.23 to 5.09)
Conclusions
• Interventions to reduce wasting in early
childhood may have improve linear growth
• Instances of wasting may not be the primary
cause of stunting
Conclusions
• Interventions to reduce wasting in early
childhood may have improve linear growth
• Instances of wasting may not be the primary
cause of stunting
Acknowledgements
• Child Malnutrition and Infection Network
investigators
• MAL-ED Network investigators