Person: Locks, Lindsey
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Locks
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Locks, Lindsey
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Publication Infant Nutritional Status and Markers of Environmental Enteric Dysfunction are Associated with Midchildhood Anthropometry and Blood Pressure in Tanzania(Mosby, 2017) Locks, Lindsey; Mwiru, Ramadhani S.; Mtisi, Expeditho; Manji, Karim P.; McDonald, Christine M.; Liu, Enju; Kupka, Roland; Kisenge, Rodrick; Aboud, Said; Gosselin, Kerri; Gillman, Matthew; Gewirtz, Andrew T.; Fawzi, Wafaie; Duggan, ChristopherObjective: To assess whether growth and biomarkers of environmental enteric dysfunction in infancy are related to health outcomes in midchildhood in Tanzania. Study design Children who participated in 2 randomized trials of micronutrient supplements in infancy were followed up in midchildhood (4.6-9.8 years of age). Anthropometry was measured at age 6 and 52 weeks in both trials, and blood samples were available from children at 6 weeks and 6 months from 1 trial. Linear regression was used for height-for-age z-score, body mass index-for-age z-score, and weight for age z-score, and blood pressure analyses; log-binomial models were used to estimate risk of overweight, obesity, and stunting in midchildhood. Results: One hundred thirteen children were followed-up. Length-for-age z-score at 6 weeks and delta length-for-age z-score from 6 to 52 weeks were associated independently and positively with height-for-age z-score and inversely associated with stunting in midchildhood. Delta weight-for-length and weight-for-age z-score were also positively associated with midchildhood height-for-age z-score. The 6-week and delta weight-for-length z-scores were associated independently and positively with midchildhood body mass index-for-age z-score and overweight, as was the 6-week and delta weight-for-age z-score. Delta length-for-age z-score was also associated with an increased risk of overweight in midchildhood. Body mass index-for-age z-score in midchildhood was associated positively with systolic blood pressure. Serum anti-flagellin IgA concentration at 6 weeks was also associated with increased blood pressure in midchildhood. Conclusions: Anthropometry at 6 weeks and growth in infancy independently predict size in midchildhood, while anti-flagellin IgA, a biomarker of environmental enteric dysfunction, in early infancy is associated with increased blood pressure in midchildhood. Interventions in early life should focus on optimizing linear growth while minimizing excess weight gain and environmental enteric dysfunction. Trial registration ClinicalTrials.gov: NCT00197730 and NCT00421668.Publication Nutrition, Growth and Health in Tanzanian Infants(2016-05-03) Locks, Lindsey; Duggan, Christopher P.; Kupka, Roland; Wang, Molin; Fawzi, Wafaie W.Undernutrition in early life increases children’s risk of mortality, morbidity, and impaired growth and development. This thesis analyzes data from two randomized controlled trials in Dar es Salaam, Tanzania. The first trial assessed the effect of daily multivitamin (vitamins B-complex, C and E) supplementation on mortality and morbidity in infants born to HIV-infected mothers. 2387 infants were randomized to multivitamins or placebo at 6 weeks and followed-up for two years. The second trial assessed the effect of zinc and/or multivitamins (vitamins B-complex, C and E) on morbidity in infants born to HIV-uninfected mothers. 2400 infants were randomized to either zinc + multivitamins, zinc only, multivitamins only, or placebo at 6 weeks and were followed for 18 months. Chapter 1 assesses the effect of zinc and/or multivitamin supplements in the second trial on longitudinal child growth – defined by change in height-for-age, weight-for-age and weight-for-height z-scores (HAZ, WAZ and WHZ) and stunting, underweight and wasting (<-2 SD 2006 WHO standard for each indicator respectively). We found small, but significant effects of supplements on change in WHZ and WAZ, but did not find a statistically significant effect of zinc and/or multivitamin supplements on stunting, wasting or underweight. Chapter 2 assesses the effect of zinc and/or multivitamin supplements in the second trial on early child development (ECD) assessed using the cognitive, motor (fine and gross) and language (receptive and expressive) scales of the Bayley Infant Scales of Development 3rd Edition (BSID-III). We did not find a significant effect of supplements on early childhood development as assessed by the BSID-III. Chapter 3 pools the two trials in order to compare mortality, morbidity and growth in HIV-infected, HIV-exposed-but-uninfected (HIV-EU) and HIV unexposed infants. HIV-infected children had the highest rates of mortality, morbidity and growth failure. HIV-EU infants had higher rates of mortality and morbidities than unexposed infants; but lower rates than their HIV-infected peers. Conclusions: Alternative approaches (beyond zinc and/or multivitamin supplementation) to improve growth and ECD in vulnerable populations should be pursued. Child health interventions should target not only HIV-infected but also HIV-EU children, given their increased susceptibility to morbidity and mortality.Publication Magnitude and determinants of inadequate third-trimester weight gain in rural Bangladesh(Public Library of Science, 2018) Hasan, S. M. Tafsir; Rahman, Sabuktagin; Locks, Lindsey; Rahman, Mizanur; Hore, Samar Kumar; Saqeeb, Kazi Nazmus; Khan, Md. Alfazal; Ahmed, TahmeedObjectives: The objective of this study was to estimate the magnitude and determinants of inadequate weight gain in the third-trimester among rural women in Matlab, Bangladesh. Methods: The study analyzed data on weight gain in the third trimester in 1,883 pregnant women in Matlab, Bangladesh. All these women were admitted to Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) for childbirth during 2012–2014, and they had singleton live births at term. Data were retrieved from the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital. A multivariable logistic regression for inadequate weight gain in the third trimester (≤4 kg) was built with sociodemographic, environmental and maternal factors as predictors. Results: One thousand and twenty-six (54%) pregnant women had inadequate weight gain in the third trimester. In the multivariable model, short stature turned out to be the most robust risk factor for inadequate weight gain in the third trimester (OR = 2.5; 95% CI 1.8, 3.5 for short compared to tall women). Pre-third-trimester BMI was inversely associated with insufficient weight gain (OR = 0.96; 95% CI 0.93, 0.99 for 1 unit increase in BMI). Other risk factors for inadequate weight gain in the third trimester were advanced age (OR = 1.9; 95% CI 1.2, 3.1 for ≥35 years compared to ≤19 years), parity (OR = 1.5; 95% CI 1.2, 1.9 for multipara compared to nulliparous women), low socioeconomic status (OR = 1.7; 95% CI 1.2, 2.3 for women in the lowest compared to women in the highest wealth quintile), low level of education (OR = 1.6; 95% CI 1.2, 2.1 for ≤5 years compared to ≥10 years of education), belonging to the Hindu religious community (OR = 1.8; 95% CI 1.3, 2.5), consuming arsenic-contaminated water (OR = 1.4; 95% CI 1.1, 1.9), and conceiving during monsoon or dry season compared to summer (OR = 1.4; 95% CI 1.1, 1.8). Conclusions: Among rural Bangladeshi women in Matlab, third-trimester weight gain was in general poor. Maternal characteristics such as short stature, low BMI, advanced age, parity, low level of education and socioeconomic status, being Hindu, intake of arsenic contaminated water, and conceiving during monsoon or dry season were the risk factors for inadequate weight gain in the third trimester. Special attention should be given during prenatal care to women with the risk factors identified in this study.