CORE Group GHPC15 October 8, 2015 Concurrent Session: Factors Associated with Growth in the First 1,000 Days: Translating Evidence into Programs for Stunting, Wasting, and the Double Burden of Malnutrition

1. Factors Associated with Growth
in the First 1000 Days
William Checkley, MD, PhD
Johns Hopkins University
October 8, 2015
wcheckl1@jhmi.edu

2. Disclosures
• Funding by the Bill & Melinda Gates
Foundation
• No conflicts of interest to disclose

3. 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.

4. Severe, acute malnutrition increases
the risk of death ...
Fishman et al. In Comparative quantification of health risks. WHO 2004.

5. … but height faltering as a result of
infection is more prevalent
Boys (n = 128) Girls (n = 96)
Age (months)
Height(cm)
WHO standard
0 10 20 30
50
60
70
80
90
0 10 20 30

6. Once stunted, it is hard to recover
Checkley et al. Int J Epidemiol 2008

7. Once stunted, it is hard to recover
Moore et al. Int J Epidemiol 2001

8. Childhood stunting has adverse
consequences on cognition
Berkman et al. Lancet 2002

9. 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

10. 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

11. Cumulative incidence

12. Cross-sectional relationship at
different ages

13. History of wasting and stunting
R=0.94, P<0.001

14. Length-for-age as a function of wasting

15. SD=0.5
SD=1
SD=0.25 SD=0.75
SD=2 SD=3
Weight-for-length variability

16. 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)

17. Conclusions
• Interventions to reduce wasting in early
childhood may have improve linear growth
• Instances of wasting may not be the primary
cause of stunting

18. Conclusions
• Interventions to reduce wasting in early
childhood may have improve linear growth
• Instances of wasting may not be the primary
cause of stunting

19. Acknowledgements
• Child Malnutrition and Infection Network
investigators
• MAL-ED Network investigators