Das Subhasish, Alam Md Ashraful, Mahfuz Mustafa, Arifeen Shams El, Ahmed Tahmeed
Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
BMJ Open. 2019 Jul 30;9(7):e025439. doi: 10.1136/bmjopen-2018-025439.
Using MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) Bangladesh birth cohort data, we sought to measure the relative contributions of the most predictive correlates of stunting to mean length-for-age z (LAZ) score difference between stunted and non-stunted children at 24 months of age.
Dhaka, Bangladesh PARTICIPANTS: 211 slum-dwelling children enrolled within 17 days of their birth.
The explanatory variables were identified from the following groups: maternal characteristics, birth characteristics, macronutrient intake, socioeconomic status, morbidity and serum micronutrient level. At step 1, predictive correlates of stunting were identified longitudinally (from 9 to 24 months of age) using generalized estimating equations (GEE) model. Then, the relative contributions of the most predictive correlates of stunting to mean LAZ score difference between stunted and non-stunted children at 24 months of age was measured using Blinder-Oaxaca decomposition analysis RESULTS: The GEE multivariable model identified maternal height, birth weight, people per room, gender, having separate room for kitchen and energy intake as the most predictive correlates of stunting. At 24 months, mean LAZ score difference between stunted and non-stunted children was 1.48. The variable by variable decomposition of the LAZ gap identified maternal height (coefficient: -3.04; 95% CI: 0.35 to -6.44), birth weight (coefficient: -0.21; 95% CI: 0.88 to -1.30), people per room (coefficient: 0.31; 95% CI: 0.92 to -0.30) and energy intake (coefficient: -0.12; 95% CI: 0.22 to -0.46) as the top most factors responsible for the mean LAZ score difference between stunted and non-stunted children at 24 months of age.
The relative contributions of maternal height and birth weight to LAZ gap signifies that improvement in nutritional status of a women during her adolescence and pregnancy would have an impact on birth weight of her offspring, and ultimately, on linear growth of the child.
利用孟加拉国MAL-ED（肠道感染与营养不良的病因、风险因素及相互作用及其对儿童健康的影响）出生队列数据，我们试图衡量发育迟缓最具预测性的相关因素对24月龄发育迟缓和非发育迟缓儿童平均年龄别身长Z评分（LAZ）差异的相对贡献。
孟加拉国达卡
211名出生后17天内入组的贫民窟儿童
解释变量来自以下几组：母亲特征、出生特征、常量营养素摄入、社会经济地位、发病率和血清微量营养素水平。第一步，使用广义估计方程（GEE）模型纵向（从9月龄至24月龄）确定发育迟缓的预测相关因素。然后，使用布林德-奥萨克分解分析衡量发育迟缓最具预测性的相关因素对24月龄发育迟缓和非发育迟缓儿童平均LAZ评分差异的相对贡献。结果：GEE多变量模型确定母亲身高、出生体重、每间房居住人数、性别、有单独的厨房以及能量摄入是发育迟缓最具预测性的相关因素。在24月龄时，发育迟缓和非发育迟缓儿童的平均LAZ评分差异为1.48。对LAZ差距进行逐个变量分解，确定母亲身高（系数：-3.04；95%置信区间：0.35至-6.44）、出生体重（系数：-0.21；95%置信区间：0.88至-1.30）、每间房居住人数（系数：0.31；95%置信区间：0.92至-0.30）和能量摄入（系数：-0.12；95%置信区间：0.22至-0.46）是导致24月龄发育迟缓和非发育迟缓儿童平均LAZ评分差异的最主要因素。
母亲身高和出生体重对LAZ差距的相对贡献表明，女性在青春期和孕期营养状况的改善会影响其后代的出生体重，最终影响儿童的线性生长。
