Relationships among common illness symptoms and the protective effect of breastfeeding in early childhood in MAL-ED : An eight-country cohort study

Funding Information: Financial support: The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the National Institutes of Health/ Fogarty International Center. Publisher Copyright: Copyright © 2018 by The American Society of Tropical Medicine and Hygiene.Peer reviewedPublisher PD

Early childhood cognitive development is affected by interactions among illness, diet, enteropathogens and the home environment : Findings from the MAL-ED birth cohort study

Funding Information: Funding The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation (#OPP47075), the Foundation for the NIH and the National Institutes of Health/Fogarty International Center. The Bill & Melinda Gates Foundation did not play any role in the writing of the manuscript nor did the funders of the study have any role in the study design, data collection, data analysis or interpretation of study results. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Publisher Copyright: © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Peer reviewedPublisher PD

Use of quantitative molecular diagnostic methods to assess the aetiology, burden, and clinical characteristics of diarrhoea in children in low-resource settings : a reanalysis of the MAL-ED cohort study

Funding Information: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is a collaborative project supported by the Bill & Melinda Gates Foundation (OPP1131125), the Foundation for the NIH, the National Institutes of Health (AI114888), and the Fogarty International Center. We thank the staff and participants of the MAL-ED Network Project for their important contributions. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US National Institutes of Health or Department of Health and Human Services. Publisher Copyright: © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licensePeer reviewedPublisher PD

Use of quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections on linear growth in children in low-resource settings : longitudinal analysis of results from the MAL-ED cohort study

Funding Information: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) was carried out as a collaborative project supported by the Bill & Melinda Gates Foundation (OPP1131125), the Foundation for the National Institutes of Health (AI130326), and the Fogarty International Center. The authors thank the staff and participants of the MAL-ED Network Project for their important contributions. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US National Institutes of Health or Department of Health and Human Services. Publisher Copyright: © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licensePeer reviewedPublisher PD

Nurturing environments and nutrient-rich diets may improve cognitive development: analysis of cognitive trajectories from six to sixty months from the MAL-ED study (OR10-01-19)

Objectives: To identify clusters of cognitive developmental trajectories and associated differentiating factors of children aged 6 to 60 months old in 5 low to middle-income sites.Methods: We followed 835 children and assessed anthropometry at enrolment (≤ 17 d old); bi-weekly illness data (0–24 and 60 mo); non-diarrheal and diarrheal stools (0–24 mo) analyzed for a panel of enteropathogens; quantitative complementary food intakes (9–24 and 60 mo); micronutrient status (Fe, Zn, Vit A; 7, 15, and 24 mo); quality of the child\u27s home environment (6, 24, and 60 mo) and maternal reasoning ability and depressive symptoms via questionnaire. Child cognitive development was assessed by the Bayley Scales of Infant Development III (6, 15 and 24 mo) and Wechsler Preschool and Primary Scale of Intelligence (60 mo). Clusters of trajectories were identified using a latent class mixed model. Differences between clusters were described using discriminant analysis to rank the contribution of each variable using correlation-adjusted t-scores (CAT).Results: Five clusters were identified. From 51 discriminatory factors, 10 had greatest descriptive power: HOME score at 60 mo (mean CAT2 ± SD: 34.6 ± 0.35), proportion of days ill from 0–24 mo (23.9 ± 0.18), years of maternal schooling (13.8 ± 0.23), mean nutrient densities of zinc (12.3 ± 0.07), protein (8.95 ± 0.09), vitamin B6 (8.2 ± 0.10), phytate (7.91 ± 0.05) and mean energy (7.82 ± 0.04) from complementary foods (9–24 mo), % days of exclusive breastfeeding (0–6 mo; 6.42 ± 0.10) and weight-for-age at enrolment (6.14 ± 0.17). The discriminant analysis model fit was statistically significant (Wilk\u27s λ 0.54, P \u3c 0.01).Conclusions: Early life factors associated with higher scoring trajectories included stimulation and support for the child in their home, complementary feeding that typified greater diversity and animal-source foods, and maternal years of schooling. Influences associated with lower scoring trajectories included lower weight at enrolment and higher prevalence of illness. Policies promoting maternal and child nutrition, education and fostering a nurturing environment are likely to have greatest impact on child development

Adequacy of Iodine Status and Associations with Gut Health : A Prospective Cohort Study among Infants in 8 Low- and Middle-Income Countries

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Characteristics associated with the transition to partial breastfeeding prior to 6 months of age : Data from seven sites in a birth cohort study

ACKNOWLEDGMENTS The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) was carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH and the NIH/Fogarty International Center.Peer reviewedPublisher PD

Influences on catch-up growth using relative versus absolute metrics : evidence from the MAL-ED cohort study

Acknowledgements The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) was a collaborative project led by the Foundation for the National Institutes of Health and the National Institutes of Health, Fogarty International Center. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. National Institutes of Health or Department of Health and Human Services. Funding The MAL-ED study was supported by the Bill & Melinda Gates Foundation, through grants to the Foundation for the National Institutes of Health, and with additional support from the National Institutes of Health, Fogarty Inter- national Center. The funder had no direct role in the writing of the manu- script or in the study design, data collection, analysis or interpretation of study results. We are grateful to the children and caregivers who participated in the study for their invaluable contributions.Peer reviewedPublisher PD

Exposure to aflatoxin and fumonisin in children at risk for growth impairment in rural Tanzania

Growth impairment is a major public health issue for children in Tanzania. The question remains as to whether dietary mycotoxins play a role in compromising children's growth. We examined children's exposures to dietary aflatoxin and fumonisin and potential impacts on growth in 114 children under 36 months of age in Haydom, Tanzania. Plasma samples collected from the children at 24 months of age (N = 60) were analyzed for aflatoxin B₁-lysine (AFB₁-lys) adducts, and urine samples collected between 24 and 36 months of age (N = 94) were analyzed for urinary fumonisin B₁ (UFB₁). Anthropometric, socioeconomic, and nutritional parameters were measured and growth parameter z-scores were calculated for each child. Seventy-two percent of the children had detectable levels of AFB₁-lys, with a mean level of 5.1 (95% CI: 3.5, 6.6) pg/mg albumin; and 80% had detectable levels of UFB₁, with a mean of 1.3 (95% CI: 0.8, 1.8) ng/ml. This cohort had a 75% stunting rate [height-for-age z-scores (HAZ) < −2] for children at 36 months. No associations were found between aflatoxin exposures and growth impairment as measured by stunting, underweight [weight-for-age z-scores (WAZ) < −2], or wasting [weight-for-height z-scores (WHZ) < −2]. However, fumonisin exposure was negatively associated with underweight (with non-detectable samples included, p = 0.0285; non-detectable samples excluded, p = 0.005) in this cohort of children. Relatively low aflatoxin exposure at 24 months was not linked with growth impairment, while fumonisin exposure at 24–36 months based on the UFB₁ biomarkers may contribute to the high growth impairment rate among children of Haydom, Tanzania; which may be associated with their breast feeding and weaning practices

Full breastfeeding protection against common enteric bacteria and viruses : results from the MAL-ED cohort study

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