Document Detail


The prevalence of stunting is high in HIV-1-exposed uninfected infants in Kenya.
MedLine Citation:
PMID:  22378334     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
As prevention of mother-to-child HIV-1 transmission (PMTCT) programs decrease the numbers of HIV-1-infected infants, it remains important to improve growth in HIV-1-exposed, uninfected (EU) infants. To determine the growth rate and predictors of growth faltering in breast-fed and formula-fed EU infants, growth analyses [weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores] were conducted by using data from a randomized feeding trial in HIV-1-infected women in Kenya. Growth faltering in EU infants was compared based on randomization to breastfeeding (BF) or formula feeding (FF) using Cox proportional hazards regression models. Linear mixed-effects models determined rate and cofactors of length growth. Among 338 EU infants, 164 (49%) were breast-fed and 174 (51%) formula-fed. In both arms, growth declined steadily during follow-up. By 2 y, 29% of children were underweight (WAZ < -2), 18% were wasted (WLZ < -2), and 58% were stunted (LAZ < -2), with no differences by feeding arm. Higher maternal education (y) and taller stature (cm) were associated with a decreased risk of underweight and stunting [underweight: adjusted HR (aHR) = 0.90 (95% CI: 0.83, 0.99), P = 0.03, and aHR = 0.92 (95% CI: 0.87, 0.97), P = 0.002; and stunting: aHR = 0.91 (95% CI: 0.85, 0.97), P = 0.003, and aHR = 0.96 (95% CI: 0.92, 0.99), P = 0.02, respectively]. Diarrhea was associated with an increased risk of wasting [aHR = 2.26 (95% CI: 1.11, 4.62), P = 0.03]. In multivariate analyses, FF was associated with slower declines in length velocity [0.24 LAZ/y (95% CI: 0.06, 0.43), P = 0.009]. Despite being uninfected, HIV-1-exposed infants showed frequent growth faltering, suggesting the need for vigilance in recognizing stunting within PMTCT programs. The slower rate of decline in length growth with FF may reflect benefits of micronutrients. Because BF is the best option for HIV-1-infected mothers in resource-limited settings, nutritional interventions should be examined for their impact on growth in EU breast-fed infants.
Authors:
Christine J McGrath; Ruth Nduati; Barbra A Richardson; Alan R Kristal; Dorothy Mbori-Ngacha; Carey Farquhar; Grace C John-Stewart
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-02-29
Journal Detail:
Title:  The Journal of nutrition     Volume:  142     ISSN:  1541-6100     ISO Abbreviation:  J. Nutr.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-21     Completed Date:  2012-05-16     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0404243     Medline TA:  J Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  757-63     Citation Subset:  IM    
Affiliation:
Departments of Epidemiology, University of Washington, Seattle, WA, USA. mcgrathc@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Breast Feeding
Child Development*
Cohort Studies
Diarrhea / epidemiology,  physiopathology
Educational Status
Female
Follow-Up Studies
Growth Disorders / complications,  epidemiology*
HIV Seropositivity / complications*,  immunology
HIV-1* / immunology
Humans
Incidence
Infant Formula / administration & dosage
Infant, Newborn
Kenya / epidemiology
Male
Prevalence
Proportional Hazards Models
Thinness / epidemiology
Wasting Syndrome / epidemiology,  etiology
Grant Support
ID/Acronym/Agency:
D43-TW00007/TW/FIC NIH HHS; K24 AI087399/AI/NIAID NIH HHS; K24 HD054314/HD/NICHD NIH HHS; NICHD-23412//PHS HHS; P30 AI027757/AI/NIAID NIH HHS; TL1 RR025016/RR/NCRR NIH HHS; TL1 TR000422/TR/NCATS NIH HHS; UL1 TR000423/TR/NCATS NIH HHS
Comments/Corrections

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