Factors Associated with Growth

in the First 1000 Days

William Checkley, MD, PhD

Johns Hopkins University

October 8, 2015

wcheckl1@jhmi.edu

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