Biomass smoke exposure and somatic growth among children: The RESPIRE and CRECER prospective cohort studies in rural Guatemala

Wenxin Lu; Alisa Jenny; Carolina Romero; Anaite Diaz-Artiga; Andrea Kuster; Eduardo Canuz; Ajay Pillarisetti; John P McCracken; Wenzhong Huang; Kirk R Smith; John Balmes; Lisa M Thompson

doi:10.1016/j.envint.2023.108401

Biomass smoke exposure and somatic growth among children: The RESPIRE and CRECER prospective cohort studies in rural Guatemala

Environ Int. 2024 Jan:183:108401. doi: 10.1016/j.envint.2023.108401. Epub 2023 Dec 22.

Authors

Affiliations

¹ School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA. Electronic address: wluac@berkeley.edu.
² Institute for Global Health Sciences, University of California, San Francisco, 94158 San Francisco, CA, USA. Electronic address: alisa.jenny@ucsf.edu.
³ Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala. Electronic address: bcromero@gmail.com.
⁴ Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala. Electronic address: adiaz@ces.uvg.edu.gt.
⁵ School of Nursing, University of California, San Francisco, 94158 San Francisco, CA, USA. Electronic address: Andrea.Kuster@ucsf.edu.
⁶ Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala. Electronic address: ecanuz@gmail.com.
⁷ School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA. Electronic address: ajaypillarisetti@berkeley.edu.
⁸ Epidemiology and Biostatistics Department, University of Georgia, 30606 Athens, GA, USA. Electronic address: john.mccracken@uga.edu.
⁹ Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: wenzhong.huang@monash.edu.
¹⁰ School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA.
¹¹ School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: john.balmes@ucsf.edu.
¹² Nell Hodgson Woodruff School of Nursing, Emory University, 30322 Atlanta, GA, USA. Electronic address: lisa.thompson@emory.edu.

PMID: 38147790
DOI: 10.1016/j.envint.2023.108401

Abstract

Background: Cooking-related biomass smoke is a major source of household air pollution (HAP) and an important health hazard. Prior studies identified associations between HAP exposure and childhood stunting; less is known for underweight and wasting. Few studies had personal HAP measurements.

Methods: 557 households in rural Guatemala were enrolled in the CRECER study, the follow-up study of the RESPIRE randomized intervention trial. They were assigned to three groups that received chimney stoves at different ages of the study children. Multiple personal carbon monoxide (CO) exposure measurements were used as proxies for HAP exposures. Children's heights and weights were measured from 24 to 60 months of age. Height-for-age z-score (HAZ), weight-for-age z-score (WAZ), and weight-for-height z-score (WHZ) were calculated based on the World Health Organization's Multicentre Growth Reference Study. HAZ, WAZ, and WHZ below -2 were classified as stunting, underweight, and wasting, respectively. Generalized linear models and mixed effects models were applied.

Results: 541 children had valid anthropometric data, among whom 488 (90.2 %) were stunted, 192 (35.5 %) were underweight, and 2 (0.3 %) were wasted. A 1 ppm higher average CO exposure was associated with a 0.21 lower HAZ (95 % CI: 0.17-0.25), a 0.13 lower WAZ (95 % CI: 0.10-0.17) and a 0.06 lower WHZ (95 % CI: 0.02-0.10).The associations for HAZ were stronger among boys (coefficient = -0.29, 95 % CI: -0.35 - -0.22) than among girls (coefficient = -0.15, 95 % CI: -0.20 - -0.10). A 1 ppm-year higher cumulative CO exposure was associated with a higher risk of moderate stunting among boys (OR = 1.27, 95 % CI: 1.05-1.59), but not among girls.

Discussion: In this rural Guatemalan population, higher HAP exposure was associated with lower HAZ and WAZ. The associations between HAP and HAZ/stunting were stronger among boys. Reducing HAP might benefit childhood somatic growth in rural populations of low-income countries.

Keywords: Biomass smoke; Carbon monoxide; Child health; Household air pollution; Somatic growth.

MeSH terms

Biomass
Child, Preschool
Female
Follow-Up Studies
Growth Disorders* / epidemiology
Guatemala / epidemiology
Humans
Infant
Male
Prospective Studies
Rural Population
Smoke* / adverse effects
Thinness / epidemiology

Substances

Smoke

Grants and funding

T42 OH008429/OH/NIOSH CDC HHS/United States