Causes and consequences of child growth faltering in low-resource settings
Authors: Mertens Andrew , Benjamin-Chung Jade , Colford John M. , Coyle Jeremy , van der Laan Mark J. , Hubbard Alan E. , Rosete Sonali , Malenica Ivana , Hejazi Nima , Sofrygin Oleg , Cai Wilson , Li Haodong , Nguyen Anna , Pokpongkiat Nolan N. , Djajadi Stephanie , Seth Anmol , Jung Esther , Chung Esther O. , Jilek Wendy , Subramoney Vishak , Hafen Ryan , Häggström Jonas , Norman Thea , Brown Kenneth H. , Christian Parul , Arnold Benjamin F. ,   The Ki Child Growth Consortium, Abbeddou Souheila , Adair Linda S. , Ahmed Tahmeed , Ali Asad , Ali Hasmot , Ashorn Per , Bahl Rajiv , Barreto Mauricio L. , Becquey Elodie , Begín France , Bessong Pascal Obong , Bhan Maharaj Kishan , Bhandari Nita , Bhargava Santosh K. , Bhutta Zulfiqar A. , Black Robert E. , Bodhidatta Ladaporn , Carba Delia , Checkley William , Christian Parul , Crabtree Jean E. , Dewey Kathryn G. , Duggan Christopher P. , Fall Caroline H. D. , Faruque Abu Syed Golam , Fawzi Wafaie W. , da Silva Filho José Quirino , Gilman Robert H. , Guerrant Richard L. , Haque Rashidul , Hasan S. M. Tafsir , Hess Sonja Y. , Houpt Eric R. , Humphrey Jean H. , Iqbal Najeeha Talat , Jimenez Elizabeth Yakes , John Jacob , John Sushil Matthew , Kang Gagandeep , Kosek Margaret , Kramer Michael S. , Labrique Alain , Lee Nanette R. , Lima Aldo Ângelo Moreira , Mahopo Tjale Cloupas , Maleta Kenneth , Manandhar Dharma S. , Manji Karim P. , Martorell Reynaldo , Mazumder Sarmila , Mduma Estomih , Mohan Venkata Raghava , Moore Sophie E. , Ntozini Robert , Nyathi Mzwakhe Emanuel , Olortegui Maribel Paredes , Ouédraogo Césaire T. , Petri William A. , Premkumar Prasanna Samuel , Prentice Andrew M. , Rahman Najeeb , Ramirez-Zea Manuel , Sachdev Harshpal Singh , Sadiq Kamran , Sarkar Rajiv , Sarmin Monira , Saville Naomi M. , Shaikh Saijuddin , Shrestha Bhim P. , Shrestha Sanjaya Kumar , Soares Alberto Melo , Sonko Bakary , Stein Aryeh D. , Svensen Erling , Syed Sana , Umrani Fayaz , Ward Honorine D. , West Keith P. , Wu Lee Shu Fune , Yang Seungmi , Yori Pablo Penataro 
Published: September 2023

Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-agez-scores of up to 0.40 and weight-for-lengthz-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.