The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya

Christine J. McGrath, Ruth Nduati, Barbra A. Richardson, Alan R. Kristal, Dorothy Mbori-Ngacha, Carey Farquhar, Grace C. John-Stewart

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

As prevention of mother-to-child HIV-1 transmission (PMTCT) programs decrease the numbers of HIV-1-infected infants, it remains important to improve growth in HIV-1-exposed, uninfected (EU) infants. To determine the growth rate and predictors of growth faltering in breast-fed and formula-fed EU infants, growth analyses [weight-for-age (WAZ), weight-forlength (WLZ), and length-for-age (LAZ) Z-scores] were conducted by using data from a randomized feeding trial in HIV-1-infected women in Kenya. Growth faltering in EU infants was compared based on randomization to breastfeeding (BF) or formula feeding (FF) using Cox proportional hazards regression models. Linear mixed-effects models determined rate and cofactors of length growth. Among 338 EU infants, 164 (49%) were breast-fed and 174 (51%) formula-fed. In both arms, growth declined steadily during follow-up. By 2 y, 29% of children were underweight (WAZ < -2), 18% were wasted (WLZ < -2), and 58% were stunted (LAZ < -2), with no differences by feeding arm. Higher maternal education (y) and taller stature (cm) were associated with a decreased risk of underweight and stunting [underweight: adjusted HR (aHR) = 0.90 (95% CI: 0.83, 0.99), P = 0.03, and aHR = 0.92 (95% CI: 0.87, 0.97), P = 0.002; and stunting: aHR = 0.91 (95% CI: 0.85, 0.97), P = 0.003, and aHR = 0.96 (95% CI: 0.92, 0.99), P = 0.02, respectively]. Diarrhea was associated with an increased risk of wasting [aHR = 2.26 (95% CI: 1.11, 4.62), P = 0.03]. In multivariate analyses, FF was associated with slower declines in length velocity [0.24 LAZ/y (95% CI: 0.06, 0.43), P = 0.009]. Despite being uninfected, HIV-1-exposed infants showed frequent growth faltering, suggesting the need for vigilance in recognizing stunting within PMTCT programs. The slower rate of decline in length growth with FF may reflect benefits of micronutrients. Because BF is the best option for HIV-1-infected mothers in resource-limited settings, nutritional interventions should be examined for their impact on growth in EU breast-fed infants.

Original languageEnglish (US)
Pages (from-to)757-763
Number of pages7
JournalJournal of Nutrition
Volume142
Issue number4
DOIs
StatePublished - Apr 1 2012
Externally publishedYes

Fingerprint

Growth Disorders
Kenya
HIV-1
Growth
Thinness
Mothers
Breast
Breast Feeding
Arm
Weights and Measures
Micronutrients
Random Allocation
Proportional Hazards Models
Diarrhea
Multivariate Analysis

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Medicine(all)

Cite this

McGrath, C. J., Nduati, R., Richardson, B. A., Kristal, A. R., Mbori-Ngacha, D., Farquhar, C., & John-Stewart, G. C. (2012). The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya. Journal of Nutrition, 142(4), 757-763. https://doi.org/10.3945/jn.111.148874

The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya. / McGrath, Christine J.; Nduati, Ruth; Richardson, Barbra A.; Kristal, Alan R.; Mbori-Ngacha, Dorothy; Farquhar, Carey; John-Stewart, Grace C.

In: Journal of Nutrition, Vol. 142, No. 4, 01.04.2012, p. 757-763.

Research output: Contribution to journalArticle

McGrath, CJ, Nduati, R, Richardson, BA, Kristal, AR, Mbori-Ngacha, D, Farquhar, C & John-Stewart, GC 2012, 'The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya', Journal of Nutrition, vol. 142, no. 4, pp. 757-763. https://doi.org/10.3945/jn.111.148874
McGrath CJ, Nduati R, Richardson BA, Kristal AR, Mbori-Ngacha D, Farquhar C et al. The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya. Journal of Nutrition. 2012 Apr 1;142(4):757-763. https://doi.org/10.3945/jn.111.148874
McGrath, Christine J. ; Nduati, Ruth ; Richardson, Barbra A. ; Kristal, Alan R. ; Mbori-Ngacha, Dorothy ; Farquhar, Carey ; John-Stewart, Grace C. / The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya. In: Journal of Nutrition. 2012 ; Vol. 142, No. 4. pp. 757-763.
@article{c8afb12339f247f5a4d93ab995fc3853,
title = "The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya",
abstract = "As prevention of mother-to-child HIV-1 transmission (PMTCT) programs decrease the numbers of HIV-1-infected infants, it remains important to improve growth in HIV-1-exposed, uninfected (EU) infants. To determine the growth rate and predictors of growth faltering in breast-fed and formula-fed EU infants, growth analyses [weight-for-age (WAZ), weight-forlength (WLZ), and length-for-age (LAZ) Z-scores] were conducted by using data from a randomized feeding trial in HIV-1-infected women in Kenya. Growth faltering in EU infants was compared based on randomization to breastfeeding (BF) or formula feeding (FF) using Cox proportional hazards regression models. Linear mixed-effects models determined rate and cofactors of length growth. Among 338 EU infants, 164 (49{\%}) were breast-fed and 174 (51{\%}) formula-fed. In both arms, growth declined steadily during follow-up. By 2 y, 29{\%} of children were underweight (WAZ < -2), 18{\%} were wasted (WLZ < -2), and 58{\%} were stunted (LAZ < -2), with no differences by feeding arm. Higher maternal education (y) and taller stature (cm) were associated with a decreased risk of underweight and stunting [underweight: adjusted HR (aHR) = 0.90 (95{\%} CI: 0.83, 0.99), P = 0.03, and aHR = 0.92 (95{\%} CI: 0.87, 0.97), P = 0.002; and stunting: aHR = 0.91 (95{\%} CI: 0.85, 0.97), P = 0.003, and aHR = 0.96 (95{\%} CI: 0.92, 0.99), P = 0.02, respectively]. Diarrhea was associated with an increased risk of wasting [aHR = 2.26 (95{\%} CI: 1.11, 4.62), P = 0.03]. In multivariate analyses, FF was associated with slower declines in length velocity [0.24 LAZ/y (95{\%} CI: 0.06, 0.43), P = 0.009]. Despite being uninfected, HIV-1-exposed infants showed frequent growth faltering, suggesting the need for vigilance in recognizing stunting within PMTCT programs. The slower rate of decline in length growth with FF may reflect benefits of micronutrients. Because BF is the best option for HIV-1-infected mothers in resource-limited settings, nutritional interventions should be examined for their impact on growth in EU breast-fed infants.",
author = "McGrath, {Christine J.} and Ruth Nduati and Richardson, {Barbra A.} and Kristal, {Alan R.} and Dorothy Mbori-Ngacha and Carey Farquhar and John-Stewart, {Grace C.}",
year = "2012",
month = "4",
day = "1",
doi = "10.3945/jn.111.148874",
language = "English (US)",
volume = "142",
pages = "757--763",
journal = "Journal of Nutrition",
issn = "0022-3166",
publisher = "American Society for Nutrition",
number = "4",

}

TY - JOUR

T1 - The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya

AU - McGrath, Christine J.

AU - Nduati, Ruth

AU - Richardson, Barbra A.

AU - Kristal, Alan R.

AU - Mbori-Ngacha, Dorothy

AU - Farquhar, Carey

AU - John-Stewart, Grace C.

PY - 2012/4/1

Y1 - 2012/4/1

N2 - As prevention of mother-to-child HIV-1 transmission (PMTCT) programs decrease the numbers of HIV-1-infected infants, it remains important to improve growth in HIV-1-exposed, uninfected (EU) infants. To determine the growth rate and predictors of growth faltering in breast-fed and formula-fed EU infants, growth analyses [weight-for-age (WAZ), weight-forlength (WLZ), and length-for-age (LAZ) Z-scores] were conducted by using data from a randomized feeding trial in HIV-1-infected women in Kenya. Growth faltering in EU infants was compared based on randomization to breastfeeding (BF) or formula feeding (FF) using Cox proportional hazards regression models. Linear mixed-effects models determined rate and cofactors of length growth. Among 338 EU infants, 164 (49%) were breast-fed and 174 (51%) formula-fed. In both arms, growth declined steadily during follow-up. By 2 y, 29% of children were underweight (WAZ < -2), 18% were wasted (WLZ < -2), and 58% were stunted (LAZ < -2), with no differences by feeding arm. Higher maternal education (y) and taller stature (cm) were associated with a decreased risk of underweight and stunting [underweight: adjusted HR (aHR) = 0.90 (95% CI: 0.83, 0.99), P = 0.03, and aHR = 0.92 (95% CI: 0.87, 0.97), P = 0.002; and stunting: aHR = 0.91 (95% CI: 0.85, 0.97), P = 0.003, and aHR = 0.96 (95% CI: 0.92, 0.99), P = 0.02, respectively]. Diarrhea was associated with an increased risk of wasting [aHR = 2.26 (95% CI: 1.11, 4.62), P = 0.03]. In multivariate analyses, FF was associated with slower declines in length velocity [0.24 LAZ/y (95% CI: 0.06, 0.43), P = 0.009]. Despite being uninfected, HIV-1-exposed infants showed frequent growth faltering, suggesting the need for vigilance in recognizing stunting within PMTCT programs. The slower rate of decline in length growth with FF may reflect benefits of micronutrients. Because BF is the best option for HIV-1-infected mothers in resource-limited settings, nutritional interventions should be examined for their impact on growth in EU breast-fed infants.

AB - As prevention of mother-to-child HIV-1 transmission (PMTCT) programs decrease the numbers of HIV-1-infected infants, it remains important to improve growth in HIV-1-exposed, uninfected (EU) infants. To determine the growth rate and predictors of growth faltering in breast-fed and formula-fed EU infants, growth analyses [weight-for-age (WAZ), weight-forlength (WLZ), and length-for-age (LAZ) Z-scores] were conducted by using data from a randomized feeding trial in HIV-1-infected women in Kenya. Growth faltering in EU infants was compared based on randomization to breastfeeding (BF) or formula feeding (FF) using Cox proportional hazards regression models. Linear mixed-effects models determined rate and cofactors of length growth. Among 338 EU infants, 164 (49%) were breast-fed and 174 (51%) formula-fed. In both arms, growth declined steadily during follow-up. By 2 y, 29% of children were underweight (WAZ < -2), 18% were wasted (WLZ < -2), and 58% were stunted (LAZ < -2), with no differences by feeding arm. Higher maternal education (y) and taller stature (cm) were associated with a decreased risk of underweight and stunting [underweight: adjusted HR (aHR) = 0.90 (95% CI: 0.83, 0.99), P = 0.03, and aHR = 0.92 (95% CI: 0.87, 0.97), P = 0.002; and stunting: aHR = 0.91 (95% CI: 0.85, 0.97), P = 0.003, and aHR = 0.96 (95% CI: 0.92, 0.99), P = 0.02, respectively]. Diarrhea was associated with an increased risk of wasting [aHR = 2.26 (95% CI: 1.11, 4.62), P = 0.03]. In multivariate analyses, FF was associated with slower declines in length velocity [0.24 LAZ/y (95% CI: 0.06, 0.43), P = 0.009]. Despite being uninfected, HIV-1-exposed infants showed frequent growth faltering, suggesting the need for vigilance in recognizing stunting within PMTCT programs. The slower rate of decline in length growth with FF may reflect benefits of micronutrients. Because BF is the best option for HIV-1-infected mothers in resource-limited settings, nutritional interventions should be examined for their impact on growth in EU breast-fed infants.

UR - http://www.scopus.com/inward/record.url?scp=84861122631&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861122631&partnerID=8YFLogxK

U2 - 10.3945/jn.111.148874

DO - 10.3945/jn.111.148874

M3 - Article

VL - 142

SP - 757

EP - 763

JO - Journal of Nutrition

JF - Journal of Nutrition

SN - 0022-3166

IS - 4

ER -