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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

Author

Listed:
  • 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

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.

Suggested Citation

  • 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 & , 2020. "Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-16, January.
  • Handle: RePEc:plo:pone00:0227839
    DOI: 10.1371/journal.pone.0227839
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    References listed on IDEAS

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    1. Contreras, Dante & González, Stephanie, 2015. "Determinants of early child development in Chile: Health, cognitive and demographic factors," International Journal of Educational Development, Elsevier, vol. 40(C), pages 217-230.
    2. Luca Ronfani & Liza Vecchi Brumatti & Marika Mariuz & Veronica Tognin & Maura Bin & Valentina Ferluga & Alessandra Knowles & Marcella Montico & Fabio Barbone, 2015. "The Complex Interaction between Home Environment, Socioeconomic Status, Maternal IQ and Early Child Neurocognitive Development: A Multivariate Analysis of Data Collected in a Newborn Cohort Study," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-13, May.
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    1. Johanna Beckmann & Christin Lang & Rosa du Randt & Annelie Gresse & Kurt Z. Long & Sebastian Ludyga & Ivan Müller & Siphesihle Nqweniso & Uwe Pühse & Jürg Utzinger & Cheryl Walter & Markus Gerber, 2021. "Prevalence of Stunting and Relationship between Stunting and Associated Risk Factors with Academic Achievement and Cognitive Function: A Cross-Sectional Study with South African Primary School Childre," IJERPH, MDPI, vol. 18(8), pages 1-17, April.

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