Stunting Clinical Trial
Official title:
Relationship Between Maternal Exposure to Mycotoxins, Birth Outcomes and Stunting in Infants: A Birth Cohort Study in Nepal
The study focuses on the causal relationship between mycotoxin exposure (particularly aflatoxin B1), birth outcomes, and height for age among young children in Nepal. Previous studies have shown a strong association of stunting with mycotoxin exposure yet causality has not been proven. Thus, this study will provide a better understanding of the association between maternal and/or early life mycotoxin exposure (rates in the blood and breast milk) and infant and young child growth. This information is essential if we are to more fully understand and effectively address the high rates of stunting in Asia.
In 2012, a research prioritization meeting organized by IFPRI and the Bill and Melinda Gates
Foundation on food-borne toxins concluded, "While there is solid association of stunting with
exposure to mycotoxins, the causality has not been proven and the percentage of stunting
attributable to mycotoxins in general or to specific mycotoxins is not known." (IFPRI/BMGF
2012) In other words, the extent of the problem, although widely suspected, has been poorly
documented and the biological mechanisms thought to be involved remain poorly understood.
To contribute to a better understanding of the mycotoxin-stunting relationship, the Feed the
Future Feed the Future Nutrition Innovation Lab-Asia proposes to explore the impact of
mycotoxins, with a focus on mycotoxins on child nutrition in Nepal. Through its PoSHAN study,
the Nutrition Innovation Lab-Asia is currently undertaking research in Nepal in collaboration
with the Child Health Division of the Ministry of Health and Population and multiple local
partners on how investments in agriculture can achieve significant impacts on maternal and
child nutrition, and on demonstrating how large-scale programs best incorporate such evidence
into cost-effective multi-sectoral interventions. Adding a study component on food safety
(mycotoxin contamination of the food supply) will significantly enhance our understanding of
nutrition outcomes linked to investments in agriculture. As noted by participants of the
IFPRI/BMGF (2012) meeting, "only 35% of stunting of children can be attributed to known
factors". This leaves room for research to uncover other suspected contributors to the
world's huge nutrition problems, which could then lead testable recommendations for
innovative interventions to address newly identified factors. The team will assess current
mycotoxin risk so that potential mitigation strategies can be developed.
Given the significant statistical associations shown between mycotoxin exposure in children
and height gain in infants and young children, the Nutrition Innovation Lab-Asia will
undertake an mycotoxin birth cohort study to further the understanding of the causal
relationship between past and current mycotoxin exposure (maternal and infant), birth
outcomes and length-for-age in Nepali infants and young children. The study will also seek to
validate the use of low cost data collection methods (e.g. dried blood spots versus venous
blood samples) for mycotoxin analysis.
The specific aims of this study are:
1. To examine the relationship of maternal mycotoxin exposure in pregnancy and birth
outcomes, including infant birth weight.
2. To examine the relationship of exposure to mycotoxin of infants through breast milk and
their linear growth.
3. To examine the relationship of exposure to mycotoxin through complementary feeding and
linear growth.
4. To enumerate the relative contributions of maternal and infant mycotoxin exposures in
impairing linear growth, controlling for other potential explanatory factors.
Controlling for factors such as diet, maternal education, maternal height and BMI, household
socio-economic status, infections and inflammation, and other elements such as storage
patterns, knowledge of food contaminants and mitigation practices, the specific hypotheses of
this study are:
1. There is an incremental effect of in utero, lactation and complementary feeding
mycotoxin exposures on rate of length gain and stunting outcomes for age Z-scores in
children at 2 year of age.
2. Maternal exposure to mycotoxins will be significant predictor of birth weight in
infants, thereby being a significant contributor to the burden of stunting at 2 years of
age.
3. Exposure to mycotoxins through breast milk before 6 months of age along with continued
exposure through both breast milk and complementary foods (after 6 months of age) is a
significant contributor to the burden of stunting at 2 years of age.
4. Improper farm management, food processing and storage practices are significantly
related to higher levels of serum mycotoxins in the blood of mothers and their children.
5. Knowledge of the problem of food-borne contaminants is associated with improved food
processing and storage practices.
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