Drivers of stunting and wasting across serial cross-sectional household surveys of children under 2 years of age in Pakistan: potential contribution of ecological factors

作者：Muhammad Islam, Shaukat Ali, Haris Majeed, Rafey Ali, Imran Ahmed, Sajid Soofi, Zulfiqar A Bhutta · 发表于：American Journal of Clinical Nutrition · 年份：2025 · DOI：10.1016/j.ajcnut.2025.01.003 · 被引用次数：11 · 研究领域：Child Nutrition and Water Access、Breastfeeding Practices and Influences、Child Nutrition and Feeding Issues

BACKGROUND: The impact of direct and indirect drivers on linear growth and wasting in young children is of public health interest. Although the contributions of poverty, maternal education, empowerment, and birth weight to early childhood growth are well recognized, the contribution of environmental factors like heat, precipitation, agriculture outputs, and food security in comparable datasets is less well established. OBJECTIVES: This study aims to investigate the association of length-for-age z-score (LAZ) and weight-for-length z-score (WLZ) with various indicators among children aged under 2 y in Pakistan using representative household-level nutrition surveys and ecological datasets. METHODS: Using geo-tagged metadata from Pakistan's 2011 and 2018 National Nutrition Surveys, anthropometric data from 29,887 children (9231 from 2011 and 20,656 from 2018) were analyzed. Dietary intake and food security data for 140 districts were linked to gridded data on temperature, precipitation and soil moisture, and district measures of agriculture production of edible crops. Multiple linear regressions assessed factors associated with LAZ and WLZ in index children. RESULTS: LAZ was positively associated with improved socioeconomic conditions (β = 0.06), food security (β = 0.10), birth size (β = 0.26), maternal age (β = 0.02), body mass index (β = 0.02), height (β = 0.02), and dietary score (β = 0.03). Negative associations with LAZ were found for increased temperature, precipitation, di...