Early-childhood linear growth faltering in low- and middle-income countries

Jade Benjamin-Chung (), Andrew Mertens, John M. Colford, Alan E. Hubbard, Mark J. Laan, Jeremy Coyle, Oleg Sofrygin, Wilson Cai, Anna Nguyen, Nolan N. Pokpongkiat, Stephanie Djajadi, Anmol Seth, Wendy Jilek, Esther Jung, Esther O. Chung, Sonali Rosete, Nima Hejazi, Ivana Malenica, Haodong Li, Ryan Hafen, Vishak Subramoney, Jonas Häggström, Thea Norman, Kenneth H. Brown, Parul Christian and Benjamin F. Arnold ()
Additional contact information
Jade Benjamin-Chung: Stanford University
Andrew Mertens: University of California, Berkeley
John M. Colford: University of California, Berkeley
Alan E. Hubbard: University of California, Berkeley
Mark J. Laan: University of California, Berkeley
Jeremy Coyle: University of California, Berkeley
Oleg Sofrygin: University of California, Berkeley
Wilson Cai: University of California, Berkeley
Anna Nguyen: Stanford University
Nolan N. Pokpongkiat: University of California, Berkeley
Stephanie Djajadi: University of California, Berkeley
Anmol Seth: University of California, Berkeley
Wendy Jilek: University of California, Berkeley
Esther Jung: University of California, Berkeley
Esther O. Chung: University of California, Berkeley
Sonali Rosete: University of California, Berkeley
Nima Hejazi: University of California, Berkeley
Ivana Malenica: University of California, Berkeley
Haodong Li: University of California, Berkeley
Ryan Hafen: Hafen Consulting, LLC
Vishak Subramoney: DVPL Tech
Jonas Häggström: Cytel Inc.
Thea Norman: Quantitative Sciences, Bill & Melinda Gates Foundation
Kenneth H. Brown: University of California, Davis
Parul Christian: Johns Hopkins Bloomberg School of Public Health
Benjamin F. Arnold: University of California, San Francisco

Nature, 2023, vol. 621, issue 7979, 550-557

Abstract: Abstract Globally, 149 million children under 5 years of age are estimated to be stunted (length more than 2 standard deviations below international growth standards)1,2. Stunting, a form of linear growth faltering, increases the risk of illness, impaired cognitive development and mortality. Global stunting estimates rely on cross-sectional surveys, which cannot provide direct information about the timing of onset or persistence of growth faltering—a key consideration for defining critical windows to deliver preventive interventions. Here we completed a pooled analysis of longitudinal studies in low- and middle-income countries (n = 32 cohorts, 52,640 children, ages 0–24 months), allowing us to identify the typical age of onset of linear growth faltering and to investigate recurrent faltering in early life. The highest incidence of stunting onset occurred from birth to the age of 3 months, with substantially higher stunting at birth in South Asia. From 0 to 15 months, stunting reversal was rare; children who reversed their stunting status frequently relapsed, and relapse rates were substantially higher among children born stunted. Early onset and low reversal rates suggest that improving children’s linear growth will require life course interventions for women of childbearing age and a greater emphasis on interventions for children under 6 months of age.

Date: 2023
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DOI: 10.1038/s41586-023-06418-5

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