Micronutrient adequacy is poor, but not associated with stunting between 12-24 months of age: A cohort study findings from a slum area of Bangladesh

PLoS One. 2018 Mar 29;13(3):e0195072. doi: 10.1371/journal.pone.0195072. eCollection 2018.

Abstract

The prevalence of stunting among children below 5 years of age is higher in the slum-dwelling population of Bangladesh compared to that in both urban and rural areas. Studies have reported that several factors such as inadequate nutrition, low socio-economic status, poor hygiene and sanitation and lack of maternal education are the substantial predictors of childhood stunting. Almost all these factors are universally present in the slum-dwelling population of Bangladesh. However, few studies have prospectively examined such determinants of stunting among slum populations. In this paper, we reveal the findings of a cohort study with an aim to explore the status of micronutrient adequacy among such vulnerable children and establish its association with stunting along with other determinants. Two-hundred-sixty-five children were enrolled and followed since birth until 24 months of age. We collected anthropometric, morbidity and dietary intake data monthly. We used the 24-hour multiple-pass recall approach to collect dietary intake data from the age of 9 months onward. Micronutrient adequacy of the diet was determined by the mean adequacy ratio (MAR) which was constructed from the average intake of 9 vitamins and 4 minerals considered for the analysis. We used generalized estimating equation (GEE) regression models to establish the determinants of stunting between 12-24 months of age in our study population. The prevalence of low-birth-weight (LBW) was about 28.7% and approximately half of the children were stunted by the age of 24 months. The average micronutrient intake was considerably lower than the recommended dietary allowance and the MAR was only 0.48 at 24 months of age compared to the optimum value of 1. However, the MAR was not associated with stunting between 12-24 months of age. Rather, LBW was the significant determinant (AOR = 3.03, 95% CI: 1.69-5.44) after adjusting for other factors such as age (AOR = 2.12, 95% CI: 1.45-3.11 at 24 months and AOR = 1.97, 95% CI: 1.49-2.59 at 18 months, ref: 12 months) and sex (AOR = 1.98, 95% CI: 1.17-3.33, ref: female). Improving the nutritional quality of complementary food in terms of adequacy of micronutrients is imperative for optimum growth but may not be adequate to mitigate under-nutrition in this setting. Further research should focus on identifying multiple strategies that can work synergistically to diminish the burden of stunting in resource-poor settings.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anthropometry
  • Bangladesh / epidemiology
  • Child, Preschool
  • Cohort Studies
  • Diet*
  • Female
  • Growth Disorders / chemically induced
  • Growth Disorders / epidemiology*
  • Humans
  • Infant
  • Infant Nutrition Disorders / physiopathology*
  • Infant, Newborn
  • Male
  • Micronutrients / pharmacology*
  • Nutritional Status
  • Poverty Areas
  • Prevalence
  • Rural Population
  • Young Adult

Substances

  • Micronutrients

Grants and funding

This research protocol is funded by University of Virginia (UVA) with support from MAL-ED Network Investigators in the Foundation of National Institute of Health (FNIH), Fogarty International Centre (FIC) with overall support from the Bill & Melinda Gates Foundation (BMGF). icddr,b acknowledges with gratitude the commitment of UVA, FNIH, FIC and BMGF to its research efforts. icddr,b also gratefully acknowledges the following donors who provide unrestricted support: Government of the People’s Republic of Bangladesh; Global Affairs Canada (GAC); Swedish International Development Cooperation Agency (Sida) and the Department for International Development, (UKAid).