Causes and consequences of child growth faltering in low-resource settings

Andrew Mertens, Jade Benjamin-Chung, John M. Colford, Jeremy Coyle, Mark J. van der Laan, Alan E. Hubbard, Sonali Rosete, Ivana Malenica, Nima Hejazi, Oleg Sofrygin, Wilson Cai, Haodong Li, Anna Nguyen, Nolan N. Pokpongkiat, Stephanie Djajadi, Anmol Seth, Esther Jung, Esther O. Chung, Wendy Jilek, Vishak SubramoneyRyan Hafen, Jonas Häggström, Thea Norman, Kenneth H. Brown, Parul Christian, Benjamin F. Arnold, Souheila Abbeddou, Linda S. Adair, Tahmeed Ahmed, Asad Ali, Hasmot Ali, Per Ashorn, Rajiv Bahl, Mauricio L. Barreto, Elodie Becquey, France Begín, Pascal Obong Bessong, Maharaj Kishan Bhan, Nita Bhandari, Santosh K. Bhargava, Zulfiqar A. Bhutta, Robert E. Black, Ladaporn Bodhidatta, Delia Carba, William Checkley, Parul Christian, Jean E. Crabtree, Kathryn G. Dewey, Christopher P. Duggan, Caroline H.D. Fall, Abu Syed Golam Faruque, Wafaie W. Fawzi, José Quirino da Silva Filho, Robert H. Gilman, Richard L. Guerrant, Rashidul Haque, S. M.Tafsir Hasan, Sonja Y. Hess, Eric R. Houpt, Jean H. Humphrey, Najeeha Talat Iqbal, Elizabeth Yakes Jimenez, Jacob John, Sushil Matthew John, Gagandeep Kang, Margaret Kosek, Michael S. Kramer, Alain Labrique, Nanette R. Lee, Aldo Ângelo Moreira Lima, Tjale Cloupas Mahopo, Kenneth Maleta, Dharma S. Manandhar, Karim P. Manji, Reynaldo Martorell, Sarmila Mazumder, Estomih Mduma, Venkata Raghava Mohan, Sophie E. Moore, Robert Ntozini, Mzwakhe Emanuel Nyathi, Maribel Paredes Olortegui, Césaire T. Ouédraogo, William A. Petri, Prasanna Samuel Premkumar, Andrew M. Prentice, Najeeb Rahman, Manuel Ramirez-Zea, Harshpal Singh Sachdev, Kamran Sadiq, Rajiv Sarkar, Monira Sarmin, Naomi M. Saville, Saijuddin Shaikh, Bhim P. Shrestha, Sanjaya Kumar Shrestha, Alberto Melo Soares, Bakary Sonko, Aryeh D. Stein, Erling Svensen, Sana Syed, Fayaz Umrani, Honorine D. Ward, Keith P. West, Lee Shu Fune Wu, Seungmi Yang, Pablo Penataro Yori

Research output: Contribution to journalArticlepeer-review


Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.

Original languageEnglish (US)
Pages (from-to)568-576
Number of pages9
Issue number7979
StatePublished - Sep 21 2023

ASJC Scopus subject areas

  • General


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