Early-childhood linear growth faltering in low- and middle-income countries
Authors: Benjamin-Chung Jade , Mertens Andrew , Colford John M. , Hubbard Alan E. , van der Laan Mark J. , Coyle Jeremy , Sofrygin Oleg , Cai Wilson , Nguyen Anna , Pokpongkiat Nolan N. , Djajadi Stephanie , Seth Anmol , Jilek Wendy , Jung Esther , Chung Esther O. , Rosete Sonali , Hejazi Nima , Malenica Ivana , Li Haodong , Hafen Ryan , Subramoney Vishak , 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. , Begín France , Bessong Pascal Obong , Bhan Maharaj Kishan , Bhandari Nita , Bhargava Santosh K. , Bhutta Zulfiqar A. , Black Robert E. , Bodhidatta Ladaporn , Carba Delia , Gonzalez Casanova Ines , Checkley William , 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 , 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 , Mahfuz Mustafa , Mahopo Tjale Cloupas , Maleta Kenneth , Manandhar Dharma S. , Manji Karim P. , Martorell Reynaldo , Mazumder Sarmila , Mduma Estomih , Mohan Venkata Raghava , Moore Sophie E. , Mostafa Ishita , Ntozini Robert , Nyathi Mzwakhe Emanuel , Olortegui Maribel Paredes , Petri William A. , Premkumar Prasanna Samuel , Prentice Andrew M. , Rahman Najeeb , Sachdev Harshpal Singh , Sadiq Kamran , Sarkar Rajiv , 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

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.