title: Early childhood stunting is associated with lower developmental levels in the subsequent generation of children.
abstract: BACKGROUND
  Linear growth retardation (stunting) is associated with lower adult cognition, educational attainment, and income. These effects, together with possible effects of stunting on birth weight and subsequent growth of offspring, suggest that stunting could be associated with poor development in the next generation of children.
  
  
  OBJECTIVE
  The objective was to compare developmental levels in children born to parents who were stunted or nonstunted in early childhood.
  
  
  METHODS
  This is a prospective cohort study of the children of participants in the Jamaica supplementation and stimulation study. The analysis compared children born to a parent who was stunted at age 9-24 mo, and did not receive the stimulation intervention, with children born to a parent in the nonstunted group. Developmental levels were measured with the Griffiths mental development scales between ages 12 and 72 mo. Mixed model regression analyses were conducted to allow for clustering of children within families and child (repeat assessments). The analyses included 89 children with a total of 156 assessments. Caregiver and home characteristics associated with the developmental quotient (DQ) or any of the subscales were included in the regressions.
  
  
  RESULTS
  Children born to a stunted parent had lower DQs (-5.29 points; 95% CI: -9.06, -1.52 points; P = 0.01) and lower scores on the cognitive subscale (-5.77 points; 95% CI: -10.68, -0.87 points; P = 0.022). The offspring of stunted parents had lower height-for-age (-0.61 z scores; 95% CI: -1.13, -0.10 z scores; P = 0.021). In analyses, adjusting for child height-for-age or birth weight, the developmental differences remained significant.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report comparing the development of offspring of persons stunted in early childhood to the development of offspring of nonstunted parents. The findings suggest that the impact of stunting on development continues in the next generation of children. If replicated, these findings have important implications for estimation of the cost of stunting to social and economic development.
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica; susan.walker@uwimona.edu.jm.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Walker
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica;
authors.forename: Susan M
authors.initials: SM
authors.lastname: Chang
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston, Jamaica;
authors.forename: Amika
authors.initials: A
authors.lastname: Wright
authors.affiliation: Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; and.
authors.forename: Clive
authors.initials: C
authors.lastname: Osmond
authors.affiliation: Institute of Child Health, University College, London, United Kingdom.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Grantham-McGregor
mesh_terms: D000328:Adult; D001724:Birth Weight; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007563:Jamaica; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D012959:Socioeconomic Factors
keywords: Jamaica; child development; intergenerational; linear growth; stunted children