Long run effects of early life growth faltering: a retrospective analysis of 847 birth cohorts in low- and middle-income countries

ISRCTN	ISRCTN82438662
DOI	https://doi.org/10.1186/ISRCTN82438662
Secondary identifying numbers	IRB16-0515

Submission date: 02/10/2017
Registration date: 05/10/2017
Last edited: 08/07/2019

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Other

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Plain English Summary

Background and study aims
Early life growth faltering (slower than expected rate of growth) has increasingly been recognized as a risk factor for children’s long run developmental and economic potential. While several studies have linked adult outcomes to child growth at the individual level, there is a lack of evidence on the long run benefits of reducing stunting rates at the national or subnational (population) levels. The aim of this study is to estimate the associations between early life growth faltering at the subnational (population) level and adult height and education outcomes in a representative sample of low- and middle-income countries.

Who can participate?
Adults born between 1985 and 1995 across 34 Demographic and Health Surveys (DHS) conducted between 2006 and 2014 in 24 low- and middle-income countries

What does the study involve?
Data from the DHS surveys is used to calculated average height-for-age for children under age 5 at the country-region and birth cohort level (a group of people born during a particular period or year). The measures of early life growth are then compared with adult height and educational attainment.

What are the possible benefits and risks of participating?
This study only uses de-identified data from the DHS Program and there is no further data collection.

Where is the study run from?
ICF International (USA)

When is the study starting and how long is it expected to run for?
April 2017 to September 2017

Who is funding the study?
Boston University (USA)

Who is the main contact?
Prof. Mahesh Karra

Contact information

Prof Mahesh Karra
Scientific

152 Bay State Road, Room G04C
Boston
02215
United States of America

ORCID ID	0000-0003-0962-092X

Study information

Study design	Observational cross-sectional cohort study
Primary study design	Observational
Secondary study design	Cross sectional study
Study setting(s)	Other
Study type	Other
Participant information sheet	Not available in web format, please use the contact details to request a patient information sheet
Scientific title	Long run effects of early life growth faltering: a retrospective analysis of 847 birth cohorts in low- and middle-income countries
Study hypothesis	To estimate the associations between exposure to early life growth faltering at the subnational (population) level and adult height and education outcomes in a representative sample of low- and middle-income countries.
Ethics approval(s)	This study obtained a human subjects exemption from the institutional review board at Harvard University, 05/04/2016, protocol number IRB16-0515. Only de-identified data were obtained from the Demographic and Health (DHS) survey program at https://dhsprogram.com/
Condition	Early life growth faltering (height and stunting at childhood)
Intervention	All available anthropometric data collected through the Demographic and Health Surveys (DHS) is combined to construct country-region measures of early childhood exposure to growth faltering, and this dataset is used to quantify the long-term outcomes of cohort-level changes in early life environments. The final analytic sample consists of 211,318 adult records across 34 DHS surveys that were conducted between 2006 and 2014 in 24 low- and middle-income countries. Data from the Demographic and Health Surveys were used to compute average height-for-age z-scores for children under age 5 at the country-region and birth cohort level. The cohort measures of early life growth were then linked to adult height and educational attainment. The primary exposure of interest was population-level early life growth faltering, with adult height and adult educational attainment as primary outcomes. Multivariable linear regression models were used to estimate the associations between adult outcomes and population-level measures of early life linear growth.
Intervention type	Other
Primary outcome measure	1. Adult height, measured by reported height in adulthood, taken from DHS surveys conducted between 2006 and 2014 2. Educational attainment, measured by the highest educational grade completed, taken from DHS surveys conducted between 2006 and 2014
Secondary outcome measures	No secondary outcome measures
Overall study start date	18/04/2017
Overall study end date	28/09/2017

Eligibility

Participant type(s)	Mixed
Age group	Adult
Lower age limit	18 Years
Sex	Both
Target number of participants	211,318
Participant inclusion criteria	211,318 adults who born between 1985 and 1995 across 34 DHS surveys that were conducted between 2006 and 2014 in 24 low- and middle-income countries
Participant exclusion criteria	Missing income data
Recruitment start date	01/01/1985
Recruitment end date	31/12/1995

Locations

Countries of recruitment

Burkina Faso
Cameroon
Colombia
Côte d'Ivoire
Dominican Republic
Egypt
Ghana
Haiti
Jordan
Kenya
Madagascar
Malawi
Mali
Nepal
Niger
Nigeria
Pakistan
Peru
Rwanda
Senegal
Tanzania
Uganda
United States of America
Zambia
Zimbabwe

Study participating centre

ICF International

530 Gaither Road, Suite 500
Rockville
20850
United States of America

Sponsor information

Boston University
University/education

121 Bay State Road
Boston
02215
United States of America

"ROR"	https://ror.org/05qwgg493

Funders

Funder type

University/education

Boston University
Private sector organisation / Universities (academic only)

Alternative name(s): Universitas Bostoniensis, Newbury Biblical Institute, Methodist General Biblical Institute, Boston Theological Seminary, Boston Theological Institute, BU
Location: United States of America

Results and Publications

Intention to publish date	31/12/2017
Individual participant data (IPD) Intention to share	Yes
IPD sharing plan summary	Available on request
Publication and dissemination plan	The trialists intend to submit the results of the study for publication to the American Journal of Clinical Nutrition.
IPD sharing plan	The trialists only used de-identified data from the DHS Program and were in no way involved with any of the data collection or human subjects processes. Further information about participation in a DHS survey can be found here: https://dhsprogram.com/What-We-Do/Protecting-the-Privacy-of-DHS-Survey-Respondents.cfm. The DHS data are publicly available at https://dhsprogram.com/ - the data can be accessed free of charge upon request from ICF International, the organization that manages the DHS data.

Study outputs

Output type	Details	Date created	Date added	Peer reviewed?	Patient-facing?
Results article	results	04/07/2019	08/07/2019	Yes	No

Editorial Notes

08/07/2019: Publication reference added.