Keith P West, Jr.

• DrPH, MPH, RD
• Managing Director at Johns Hopkins University

Background Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation (SQ-LNS) on small vulnerable newborn types, which...

Background The nutrition transition underway in South Asia is likely mediated by changes to the food environment. Yet, few studies have been conducted in rural areas of South Asia to describe how the food environment has changed. Objective This analysis assessed changes in household availability of and proximity to markets, grocery shops, and tea...

Adequate micronutrient intake and status are global public health goals. Vitamin and mineral deficiencies are widespread and known to impair health and survival across the life stages. However, knowledge of molecular effects, metabolic pathways, biological responses to variation in micronutrient nutriture, and abilities to assess populations for mi...

Background Does preschool height predict adult stature in undernourished settings? The extent to which preschool length or height forecasts young adult stature is unclear in chronically undernourished populations. Methods In 2006-8, we assessed height in a cohort of 2074 young adults, aged 16–23 years, in rural Nepal who, as preschoolers (≤ 4 year...

Circulating α1-acid glycoprotein (AGP) and C-reactive protein (CRP) are commonly measured to assess inflammation, but these biomarkers fail to reveal the complex molecular biology of inflammation. We mined the maternal plasma proteome to detect proteins that covary with AGP and CRP. In 435 gravida predominantly in <12-week gestation, we correlated...

Background Early and exclusive breastfeeding may reduce neonatal and post-neonatal mortality in low-resource settings. However, prelacteal feeding (PLF), the practice of giving food or liquid before breastfeeding is established, is still a barrier to optimal breastfeeding practices in many South Asian countries. We used a prospective cohort study t...

Objective To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low‐ and middle‐income countries (LMICs) from 2000 to 2017. Design Descriptive multi‐country secondary data analysis. Setting Nine LMICs in sub‐Saharan Africa, Southern and Eastern Asia, and Latin America. Population Live...

Background: Does preschool height predict adult stature in undernourished settings? The extent to which preschool length or height forecasts young adult stature is unclear in chronically undernourished populations. Methods: In 2006-8, we assessed height in a cohort of 1859 young adults, aged 16-23 years, in rural Nepal who, as preschoolers (<4 yr),...

Globally, 149 million children under 5 years of age are estimated to be stunted (length more than 2 standard deviations below international growth standards) 1,2 . Stunting, a form of linear growth faltering, increases the risk of illness, impaired cognitive development and mortality. Global stunting estimates rely on cross-sectional surveys, which...

Sustainable Development Goal 2.2—to end malnutrition by 2030—includes the elimination of child wasting, defined as a weight-for-length z -score that is more than two standard deviations below the median of the World Health Organization standards for child growth ¹ . Prevailing methods to measure wasting rely on cross-sectional surveys that cannot m...

Introduction: Arsenic methylation converts inorganic arsenic (iAs) to monomethyl (MMA) and dimethyl (DMA) arsenic compounds. Body mass index (BMI) has been positively associated with arsenic methylation efficiency (higher DMA%) in adults, but evidence in pregnancy is inconsistent. We estimated associations between anthropometric measures and arsen...

Objective: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs). Design: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. Setting: Sixteen...

Background: Arsenic exposure and micronutrient deficiencies may alter immune reactivity to influenza vaccination in pregnant women, transplacental transfer of maternal antibodies to the foetus, and maternal and infant acute morbidity. Objectives: The Pregnancy, Arsenic, and Immune Response (PAIR) Study was designed to assess whether arsenic expo...

Objective: To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications. Design: A multiple cohort individual data meta-analysis of mortality risk (within six months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness...

Objective: To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height z-score (WHZ) and weight-for-age z-score (WAZ) for predicting death over periods of one, three and six months follow-up in children. Design: Pooled analysis of 12 prospective studies examining survival after anthropometric assessment. Sensitivity...

Background: Eggs are nutrient-rich. Strengthening evidence on the impact of egg consumption on dietary quality can inform complementary feeding guidance. Objective: To assess the effect of an egg intervention on dietary intakes among six- to 12-months-olds in rural Bangladesh. Methods: We conducted a cluster-randomized controlled trial allocat...

Vitamin A deficiency (VAD) affects ~30% of preschoolers and 15% of pregnant women in low- and middle-income countries. Known to cause xerophthalmia and increase risk of mortality in children, clinical and experimental studies have also long revealed disturbed hematopoiesis and an anemia of vitamin A deficiency (VAD) that responds to vitamin A reple...

Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in child...

Background Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives To investigate the effects of multiple micronutrient s...

Environmental disasters have increased in frequency and intensity as a result of climate change. Can timely intervention help protect against the health impacts of these disasters? We study this question by leveraging data from a double-blind cluster-randomized controlled trial of at-birth vitamin A supplementation, which boosts immune system funct...

Purpose Arsenic exposure and micronutrient deficiencies may alter immune reactivity to influenza vaccination in pregnant women, transplacental transfer of maternal antibodies to the fetus, and maternal and infant acute morbidity. The Pregnancy, Arsenic, and Immune Response (PAIR) Study is a longitudinal pregnancy and birth cohort designed to assess...

Background Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10–19 years) compared to older mothers in low and middle-income...

Background: Low birth weight predicts risk of infant death. However, several birth measurements may be equally predictive, for which cutoffs and associated risks are less explored. Objectives: We assessed and optimized population cut-offs of birth length, weight, and mid-upper arm (MUAC), head (HC) and chest (CC) circumferences for predicting ne...

Background In utero or early life exposure to aflatoxin, which contaminates staple crops in disadvantaged settings, may compromise pregnancy and infant outcomes, but investigations into the extent, persistence, and determinants of aflatoxin exposure at these life stages have lacked longitudinal data collection and broad geographic representation....

Vitamin A (VA) deficiency is a public health burden, affecting ∼30% of young children and ∼15% of pregnant women in low-to-middle income countries. Xerophthalmia, the eye disease of VA deficiency, can manifest as night blindness, xerosis of the conjunctiva forming Bitot's spots or, with increased severity, corneal xerosis and potentially blinding k...

Population-based studies employing standardized diagnostics are needed to determine the burden of autism spectrum disorder (ASD) in low-resource settings. A community-based study was conducted among 8–11 year old children in rural, northwestern Bangladesh to establish the prevalence of ASD. A standardized screening and diagnosis protocol was adapte...

Background Vitamin A deficiency increases susceptibility to infection caused by impaired immune function. Objective(s) It was of interest to investigate whether immunodeficiency could facilitate the development of vitamin A deficiency. Methods Vitamin A deficiency was followed in two mouse models of immunodeficiency, the athymic nude mouse (nu/nu...

People in fragile environments face shocks that negatively affect their nutrition. Many governments put policy mechanisms in place to promote recovery of households after adverse shocks; however, resilience is difficult to measure because some apparent recovery could be the result of statistical randomness and reversion to trends. This paper demons...

Objectives Vitamin E deficiency (VED) appears to be common in rural areas of South Asia, with prevalence of ≥ 50% reported among women of reproductive age. Long term deficiency may impart neurological damage, but little information exists about persistence of VED. We provide initial estimates of chronic VED (CVED) in women of reproductive age livin...

Background Malaria causes anemia by destruction of red blood cells and inhibition of erythropoiesis. Objective We assessed whether the magnitude of the malaria-specific effect on anemia differs by age, during low and high malaria seasons. Method In rural Zambian children participating in a pro-vitamin A efficacy trial, we estimated differences in...

Background Anemia is an etiologically heterogeneous condition affecting over half of preschool-aged children in South Asia. An urgent need exists to elucidate context-specific causes of anemia to effectively address this issue. Objective This study investigated national trends and stability in the prevalence of child anemia and associated risk fac...

This study aimed to describe the timing and patterns of pubertal maturation of girls living in rural Bangladesh. Starting in September 2015, a total of 15,320 girls from a birth cohort, aged 9 to 15 years at initial encounter, were visited twice at about a one year interval, typically in their birth month. Participants were asked to self-report ext...

Background Growth failure in sub-Saharan Africa leads to a high prevalence of child stunting starting in infancy, and is attributed to dietary inadequacy, poor hygiene, and morbidity. Objectives To evaluate the impact of a program in Malawi providing a lipid-based nutrient supplement to infants from 6–23 months of age, accompanied by a social and...

Background: The prevalence of stunting in central rural Malawi is ∼50%, which prompted a multipronged nutrition program in 1 district from 2014 to 2016. The program distributed a daily, fortified, small-quantity lipid-based nutritional supplement, providing 110 kcal and 2.6 g of protein to children aged 6-23 mo, and behavior change messages around...

Background: Daily antenatal multiple micronutrient (MM) compared with iron folic acid (IFA) supplementation from early pregnancy improved birth outcomes and maternal micronutrient status in rural Bangladesh, but effects on newborn status are unknown. Objective: We examined cord blood micronutrient biomarkers in relation to antenatal MM and IFA s...

Objectives To assess the association between exposure to prelacteal feeding and infant growth from birth to 3 months of age. Methods We analyzed data from a cohort of mothers and infants (n = 2569) identified as part of ongoing pregnancy and birth surveillance in rural Gaibandha, Bangladesh. Trained interviewers visited women in their households d...

Objectives Our objective was to assess changes in prelacteal feeding practices in rural Bangladesh over a 15-year period, from ∼2004 to ∼2019, and to identify household, maternal, and infant characteristics associated with that trend. Methods The analysis used data from 21,804 infants enrolled in a cluster-randomized controlled trial of newborn vi...

Objectives To assess the impact of daily egg supplementation on infant growth from 6–12 months of age in Bangladesh. Methods A cluster randomized controlled trial was conducted in rural Bangladesh to test the effect of daily egg supplementation and nutrition education versus nutrition education alone on linear growth and stunting prevalence among...

Objectives A diverse diet helps to assure adequate micronutrient intakes and normal child growth and development. The revised minimum dietary diversity (MDD) indicator for children 6–23 months (>5 of 8 food groups) is often used to track dietary quality over time, but the influence of seasonality has not been explored. Methods We identified survey...

Objectives Vitamin A status during pregnancy is important for visual health, immune function and fetal growth and development. However, little is known about how vitamin A may affect systemic metabolic function of undernourished pregnant women. The objective of this study is to characterize metabolic signatures and pathways associated with vitamin...

Objectives Intake of high-quality protein may be insufficient to support growth in the context of high enteric pathogen carriage and environmental enteric dysfunction. Our objective was to test whether supplemental protein, with or without presumptive treatment for enteric pathogens, would improve infant growth from 6–12 months of age. Methods We...

Objectives Linear growth failure is often assessed as a height-for-age z-score (HAZ) < −2, which defines stunting. Faltering growth velocity on the other hand reveals a dynamic process, for which improving risk factors could help prevent poor growth, regardless of HAZ. Our aim was to reveal rates and risk factors of growth faltering in Nepali presc...

Objectives Vitamin E deficiency (VED), common in areas of rural South Asia, can affect neuromuscular health. This study determined the extent of VED and its association with neuromuscular function, indicated by hand grip strength, in Nepalese school aged children. Methods This cross-sectional study was conducted in a birth cohort of 6–8 year old c...

Background Preschool child anthropometric status has been assessed nationally in Nepal since 1975, with semi-decadal surveys since 1996, plus several recent, short-interval surveys to track progress toward achieving a World Health Assembly (WHA) goal to reduce stunting to 24% by 2025. Objective We report prevalence of preschool child stunting and...

Background: Four fortified complementary food supplements (CFSs) in a randomized controlled trial (RCT) were found to improve childhood linear growth in rural Bangladesh. We hypothesized children receiving these supplements would have improved micronutrient status. Methods: In the RCT, we assessed hemoglobin and serum ferritin, retinol, zinc, C-rea...

Background: Complementary food supplementation enhances linear growth and may affect body composition in children. Objective: We aimed to determine the effect of complementary food supplements provided from the age of 6 to 18 mo on fat-free mass (FFM) and fat mass (FM) gain among children in rural Bangladesh. Methods: In an unblinded, cluster-...

Undernutrition may affect fecundability, but few studies have quantified this relationship. In rural Bangladesh, where newlywed couples face strong pressures to become pregnant, we assessed fecundability, estimated by time to pregnancy (TTP), and its association with preconceptional thinness among nulligravid, newlywed female adolescents. During 20...

Household Food insecurity (HFI) is a major concern in South Asia. The pathways by which HFI may reduce child growth remain inadequately understood. In a cohort study of 12,693 maternal-infant dyads in rural Bangladesh we examined association and likely explanatory pathways linking HFI, assessed using a validated 9-item perception-based index, to in...

Nepal has a rich history of vitamin A research and a national, biannual preschool vitamin A supplementation (VAS) programme that has sustained high coverage for 25 years despite many challenges, including conflict. Key elements of programme success have included (a) evidence of a 26–30% reduction in child mortality from two, in‐country randomized t...

Estimates of the components of nutrient intake variation are needed for modeling distributions of usual intake or predicting the usual intake of individuals. Season is a potential source of variation in nutrient intakes in addition to within- and between-person variation, particularly in low- or middle-income countries. We aimed to describe seasona...

Objective To assess the extent to which maternal histories of newborn danger signs independently or combined with birth weight and/or gestational age (GA) can capture and/or predict postsecond day (age>48 hours) neonatal death. Methods Data from a cluster-randomised trial conducted in rural Bangladesh were split into development and validation set...

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Objective To assess the prevalence of missing and damaged teeth among women in the rural southern plains of Nepal using an interviewer-administered tooth assessment module. Setting 21wards in seven Village Development Committees across the Tarai of Nepal in 2015. Participants Resident, married women of children less than 5 years of age or those m...

The thymus undergoes a critical period of growth and development early in gestation and, by mid-gestation, immature thymocytes are subject to positive and negative selection. Exposure to undernutrition during these periods may permanently affect phenotype. We measured thymulin concentrations, as a proxy for thymic size and function, in children ( n...

Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal infla...

Little is known of the usual food intakes of rural adolescents in South Asia. This study describes dietary patterns, based on >91,000 7‐day food frequencies among 30,702 girls and boys, aged 9–15 years in rural northwest Bangladesh. Three intake assessments per child, taken across a calendar year, were averaged to represent individual annual intake...

Objective: To estimate the burden of anemia attributable to malaria, inflammation, and deficiency of iron or vitamin A during low and high malaria seasons among Zambian children. Study design: From a cohort of children (n = 820), 4-8 years of age participating in a randomized controlled trial of pro-vitamin A, we estimated attributable fractions...

Animal-source foods (ASFs) are a food group of interest for interventions aimed at reducing stunting and other inadequate growth measures in early childhood. The aim of this systematic review was to examine the relation between ASF consumption and stunting in children aged 6-60 mo in low- and middle-income countries (LMICs). The secondary aim was t...

Objectives: This study describes dietary patterns of women in Nepal and how dietary patterns vary by under-and-overweight, socioeconomic status (SES), and agro-ecological zone. Methods: In 2016, a national mid-year nutrition and health survey was conducted in Nepal. In each zone (mountains, hills and Tarai) 7 sub-districts (village development c...

Objectives: We assessed micronutrient status in young rural Bangladeshi adolescents to determine prevalence of deficiency by sex, age, season and dietary pattern. Methods: In a birth cohort of >30,000 youth in whom data on health, development, and nutritional status was collected in 2015-2017, venous blood was drawn from a ∼3% subsample (n = 991...

Objectives: Study objectives were to identify the prevalence and risk factors associated with the newly revised WHO indicator of minimum dietary diversity (MDD) among children aged 6-23 months in 7 countries in East and Southern Africa and to identify shared risk factors of programmatic importance across countries. Methods: MDD was defined as ha...

Objectives: Estimate the national and agro-ecological zonal prevalence of preschool child undernutrition and review temporal trends in the prevalence of undernutrition. Methods: In 2016, we conducted the last in a series of 3 (also 2013 and 2014) nationally representative, annual, same-season, mixed-longitudinal nutrition surveys - PoSHAN Commun...

Objectives: Animal source foods (ASF) promote young children's growth and development yet remain infrequently consumed in rural Nepal. Currently, agriculture and nutrition programs aim to increase ASF intake among children through small-scale animal husbandry projects. Yet the relationship between animal production and children's consumption of AS...

Objectives: Growth faltering in relation to the WHO reference is common in the first 2 years of life in South Asia. Stunting, defined as an attained height/length-for-age (H/LA) < -2 Z, is limited in its ability to capture this dynamic process. Our aims were to (1) reveal distributions of growth faltering by age in a cohort of preschool Nepali chi...

Objectives: We assessed micronutrient status in young rural Bangladeshi adolescents to determine prevalence of deficiency by sex, age, season and dietary pattern. Methods: In a birth cohort of >30,000 youth in whom data on health, development, and nutritional status was collected in 2015-2017, venous blood was drawn from a ∼3% subsample (n = 991...

Objectives: To investigate national trends in the prevalence of anemia among children and the stability of factors associated with anemia in Nepal. Methods: A series of nationally representative mid-year surveys was conducted in the same 63 wards across the mountains, hills, and Tarai of Nepal in 2013, 2014, and 2016. Each survey collected data...

Millions of children have multiple nutritional deficiencies, threatening their optimal growth, development, and quality of life. Revealing the magnitude and underlying biology of malnutrition from a greatly expanded set of practical biomarkers will be critical for developing appropriately targeted and evaluated interventions. However, our abilities...

Background: Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron-folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. Objective: We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1...

Abstract Background Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development. Methods We used data from a nationally representative survey in 21 district...

Background Little is known about the relation between unwanted pregnancy and intention discordance and maternal mental health in low-income countries. The study aim was to evaluate maternal and paternal pregnancy intentions (and intention discordance) in relation to perinatal depressive symptoms among rural Bangladeshi women. Methods Data come fro...

Proteins involved in lipoprotein metabolism can modulate cardiovascular health. While often measured to assess adult metabolic diseases, little is known about the proteomes of lipoproteins and their relation to metabolic dysregulation and underlying inflammation in undernourished child populations. The objective of this population study was to glob...

Background Biannual vitamin A supplementation is a well-established survival tool for preschool children 6 months and older in vitamin A deficient populations but this schedule misses the opportunity to intervene on most young infant deaths. Randomised trials of neonatal vitamin A supplementation (NVAS) in the first few days of life to assess its i...

Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z‐scores of height‐for‐age [HAZ], weight‐for‐h...

Background The 2015 earthquake in Nepal caused massive damages and triggered relief activities to minimize human suffering. The post-earthquake nutrition and food security situation in the hardest hit areas remains uncertain. Methods Two national cross-sectional surveys were conducted in 2014 and 2016 among households (HH) with pre-school aged chi...

Baseline characteristics of households assessed in 2014 by their post-earthquake follow-up status in 2016. (DOCX)

Baseline characteristics of households assessed in 2014 by their post-earthquake censoring due to having moved from their recorded residence or lost to follow-up by 2016. (DOCX)

Types of livestock ownership by households at the times of mid-year surveys conducted before (2014) and after (2016) the earthquake in affected areas. (DOCX)

Recovery in households that experienced shocks according to their pre-earthquake 2014 socioeconomic (SES) status. (DOCX)

Knowledge of when hands should be washed with soap and water in households with children under 5 years at the times of mid-year surveys before (2014) and after (2016) the earthquake in affected areas. (DOCX)

Stunting and mean height-for-age z-scores among children under five years at the times of surveys conducted before (2014) and after (2016) the earthquake in affected areas. (DOCX)

Average production of staple crops as reported by households during the year before the mid-2014 and 2016 surveys in earthquake-affected areas. (DOCX)