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

Autoři: Md Ashraful Alam aff001;  Stephanie A. Richard aff002;  Shah Mohammad Fahim aff001;  Mustafa Mahfuz aff001;  Baitun Nahar aff001;  Subhasish Das aff001;  Binod Shrestha aff003;  Beena Koshy aff004;  Estomih Mduma aff005;  Jessica C. Seidman aff002;  Laura E. Murray-Kolb aff006;  Laura E. Caulfield aff007;  Tahmeed Ahmed aff001
Působiště autorů: icddr,b, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh aff001;  Fogarty International Center/National Institutes of Health, Bethesda, MD, United States of America aff002;  Water Reed/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal aff003;  Christian Medical College, Vellore, India aff004;  Haydom Lutheran Hospital, Haydom, Tanzania aff005;  The Pennsylvania State University, University Park, PA, United States of America aff006;  The Johns Hopkins University, Baltimore, MD, United States of America aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227839



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.


Early-onset persistent stunting was associated with lower cognitive development in children at 5 years of age in this cohort of children.

Klíčová slova:

Birth weight – Breast feeding – Cognitive impairment – Cohort studies – Children – Inflammation – Sanitation – Socioeconomic aspects of health


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