Stunting is associated with blood lead concentration among Bangladeshi children aged 2-3 years.
Lead toxicity is of particular public health concern given its near ubiquitous distribution in nature and established neurotoxicant properties. Similar in its ubiquity and ability to inhibit neurodevelopment, early childhood stunting affects an estimated 34 % of children under 5 in low- and middle-income countries. Both lead and stunting have been shown to be associated with decreased neurodevelopment, although the relationship between these childhood burdens is underexplored. The association between lead exposure and stunting has been previously established, yet limited data are available on susceptibility windows.



Whole blood lead samples were collected from rural Bangladeshi children at delivery (umbilical cord blood) and at age 20-40 months (fingerstick blood). Stunting was determined using the Child Growth Standards developed from the World Health Organization Multicentre Growth Reference Study. Children with height for age < -2 z-scores below the median of the WHO Child Growth Standards were classified as stunted in all analyses.



Median (IQR) umbilical cord and fingerstick blood lead levels were 3.1 (1.6-6.3) μg/dl and 4.2 (1.7-7.6) μg/dl, respectively. In adjusted multivariable regression models, the odds of stunting at 20-40 months increased by 1.12 per μg/dl increase in blood lead level (OR = 1.12, 95 % CI: 1.02-1.22). No association was found between cord blood lead level and risk of stunting (OR = 0.97, 95 % CI: 0.94-1.00).



There is a significant association between stunting and concurrent lead exposure at age 20-40 months. This association is slightly attenuated after controlling for study clinic site. Additional research including more precise timing of lead exposure during these critical 20-40 months is needed.
Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA. kgleason@mail.harvard.edu.
Kelsey M
KM
Gleason
Department of Psychiatry (Biostatistics), McClean Hospital, Belmont Campus, North Belknap, Room 310A, Belmont, MA, 02478, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Linda
L
Valeri
Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 2, Room 331A, Boston, MA, 02115, USA.
A H
AH
Shankar
Dhaka Community Hospital, 190/1, Wireless Railgate Bara Moghbazar, Dhaka, 1217, Bangladesh.
Md Omar Sharif Ibne
MO
Hasan
Dhaka Community Hospital, 190/1, Wireless Railgate Bara Moghbazar, Dhaka, 1217, Bangladesh.
Quazi
Q
Quamruzzaman
Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.|Department of Neurology, Boston Children's Hospital, 651 Huntington Avenue, FXB, Room 102, Boston, MA, 02115, USA.
Ema G
EG
Rodrigues
Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.
David C
DC
Christiani
Department of Preventive Medicine, Mount Sinai School of Medicine, 17 East 102nd Street, New York, NY, 10029, USA.
Robert O
RO
Wright
Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.|Department of Neurology, Boston Children's Hospital, 651 Huntington Avenue, FXB, Room 102, Boston, MA, 02115, USA.|Department of Neurology, Harvard Medical School, 300 Longwood Ave, Children's Hospital Farley Basement Box 127, Boston, MA, 02115, USA.
David C
DC
Bellinger
Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.|Department of Neurology, Boston Children's Hospital, 651 Huntington Avenue, FXB, Room 102, Boston, MA, 02115, USA.|Department of Neurology, Harvard Medical School, 300 Longwood Ave, Children's Hospital Farley Basement Box 127, Boston, MA, 02115, USA.
Maitreyi
M
Mazumdar
D001459:Bangladesh / Q000453:epidemiology; D015362:Child Nutrition Disorders / Q000097:blood* / Q000453:epidemiology; D002675:Child, Preschool; D004784:Environmental Monitoring; D004785:Environmental Pollutants / Q000097:blood*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006130:Growth Disorders / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007854:Lead / Q000097:blood*; D008297:Male; D012424:Rural Population
D004785:Environmental Pollutants; D007854:Lead
Bangladesh; Children; Environmental toxins; Heavy metals; Lead exposure; Neurodevelopment; Stunting