Heavy Metals, Chronic Malnutrition and Neurodevelopment Among Children ...

Heavy Metals, Chronic Malnutrition and Neurodevelopment Among Children in Rural Bangladesh

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Gleason, Kelsey M. 2017. Heavy Metals, Chronic Malnutrition and Neurodevelopment Among Children in Rural Bangladesh. Doctoral dissertation, Harvard T.H. Chan School of Public Health.

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HEAVY METALS, CHRONIC MALNUTRITION AND NEURODEVELOPMENT AMONG CHILDREN IN RURAL BANGLADESH KELSEY M. GLEASON A Dissertation Submitted to the Faculty of

The Harvard T.H. Chan School of Public Health in Partial Fulfillment of the Requirements for the Degree of Doctor of Science in the Department of Environmental Health Harvard University Boston, Massachusetts. May, 2017

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Dissertation Advisor: Dr. Maitreyi Mazumdar, MD, MPH

Kelsey M. Gleason

HEAVY METALS, CHRONIC MALNUTRITION AND NEURODEVELOPMENT AMONG CHILDREN IN RURAL BANGLADESH

Abstract

Across the globe, children living in poverty are disproportionately exposed to environmental and nutritional insults that inhibit proper growth and development. Heavy metals such as lead, arsenic, and manganese are of increasing concern due to the wide range of exposure pathways and their known association with impaired neurodevelopment. Similar in its ubiquity and ability to interfere with proper neurodevelopment, early childhood chronic malnutrition plagues much of the developing world. Though children in poverty experience higher levels of chronic malnutrition and exposure to heavy metals, little is known of the relationship between environmental and nutritional exposures and their combined effects on neurodevelopment.

This research provides an in-depth investigation into the relationships between heavy metal exposure, chronic malnutrition and neurodevelopment. We take advantage of data from a prospective birth cohort of mother-child pairs in rural Bangladesh to better understand the effects of single and joint metal exposures and early childhood malnutrition on child growth and neurodevelopment.

This dissertation presents a more complete understanding of the associations between childhood environmental exposures and chronic malnutrition, and the joint effect of these insults on the neurodevelopment of children in Bangladesh.

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TABLE OF CONTENTS

Abstract(..................................................................................................................................(ii(

List(of(Figures(..........................................................................................................................(v!

List(of(Tables(..........................................................................................................................(vi!

Acknowledgements(..............................................................................................................(viii!

Introduction(...........................................................................................................................(1! OVERVIEW!OF!THESIS!....................................................................................................................................!2! BIBLIOGRAPHY!..............................................................................................................................................!4!

Chapter(1(?(Stunting(is(associated(with(blood(lead(concentration(among(Bangladeshi(children( aged(2?3(years(........................................................................................................................(7!

ABSTRACT!...................................................................................................................................................!8! BACKGROUND!..............................................................................................................................................!9! METHODS!.................................................................................................................................................!10! RESULTS!....................................................................................................................................................!15! DISCUSSION!...............................................................................................................................................!21! CONCLUSIONS!............................................................................................................................................!25! BIBLIOGRAPHY!............................................................................................................................................!26! APPENDIX!..................................................................................................................................................!34!

Chapter(2(?(Mixed(Heavy(Metal(Exposures(and(Early(Childhood(Stunting(Status(Among( Children(in(Rural(Bangladesh(.................................................................................................(36!

ABSTRACT!.................................................................................................................................................!37! INTRODUCTION!...........................................................................................................................................!38! METHODS!.................................................................................................................................................!39! RESULTS!....................................................................................................................................................!43! DISCUSSION!...............................................................................................................................................!50! CONCLUSIONS!............................................................................................................................................!56! BIBLIOGRAPHY!............................................................................................................................................!57!

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Chapter(3(?(Stunting(in(early(childhood(may(increase(susceptibility(to(adverse(effects(of( environmental(lead(exposure(on(cognition:(results(from(a(birth(cohort(in(Bangladesh(..........(62!

ABSTRACT!.................................................................................................................................................!63! INTRODUCTION!...........................................................................................................................................!64! METHODS!.................................................................................................................................................!65! RESULTS!....................................................................................................................................................!72! DISCUSSION!...............................................................................................................................................!78! CONCLUSIONS!............................................................................................................................................!82! BIBLIOGRAPHY!............................................................................................................................................!83! APPENDIX!..................................................................................................................................................!87!

Summary(...............................................................................................................................(90! BIBLIOGRAPHY!............................................................................................................................................!93!

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