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

Md Ashraful Alam, Stephanie A. Richard, Shah Mohammad Fahim, Mustafa Mahfuz, Baitun Nahar, Subhasish Das, Binod Shrestha, Beena Koshy, Estomih Mduma, Jessica C. Seidman, Laura E. Murray-Kolb, Laura E. Caulfield, Tahmeed Ahmed

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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.

Original languageEnglish (US)
Article numbere0227839
JournalPloS one
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2020

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All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

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. (2020). Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study. PloS one, 15(1), [e0227839]. https://doi.org/10.1371/journal.pone.0227839