Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh

Audrie Lin, Benjamin F. Arnold, Andrew N. Mertens, Jue Lin, Jade Benjamin-Chung, Shahjahan Ali, Alan E. Hubbard, Christine P. Stewart, Abul K. Shoab, Md Ziaur Rahman, Md Saheen Hossen, Palash Mutsuddi, Syeda L. Famida, Salma Akther, Mahbubur Rahman, Leanne Unicomb, Firdaus Dhabhar, Lia C.H. Fernald, John M. Colford, Stephen P. Luby

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Shorter childhood telomere length (TL) and more rapid TL attrition are widely regarded as manifestations of stress. However, the potential effects of health interventions on child TL are unknown. We hypothesized that a water, sanitation, handwashing (WSH), and nutritional intervention would slow TL attrition during the first two years of life. Methods: In a trial in rural Bangladesh (ClinicalTrials.gov, NCT01590095), we randomized geographical clusters of pregnant women into individual water treatment, sanitation, handwashing, nutrition, combined WSH, combined nutrition plus WSH (N + WSH), or control arms. We conducted a substudy enrolling children from the control arm and the N + WSH intervention arm. Participants and outcome assessors were not masked; analyses were masked. Relative TL was measured at 1 and 2 years after intervention, and the change in relative TL was reported. Analysis was intention-to-treat. Findings: Between May 2012 and July 2013, in the overall trial, we randomized 720 geographical clusters of 5551 pregnant women to a control or an intervention arm. In this substudy, after 1 year of intervention, we assessed a total of 662 children (341 intervention and 321 control) and 713 children after 2 years of intervention (383 intervention and 330 control). Children in the intervention arm had significantly shorter relative TL compared with controls after 1 year of intervention (difference -163 base pairs (bp), p=0.001). Between years 1 and 2, TL increased in the intervention arm (+76 bp) and decreased in the controls (-23 bp) (p=0.050). After 2 years, there was no difference between the arms (p=0.305). Interpretation: Our unexpected finding of increased telomere attrition during the first year of life in the intervention group suggests that rapid telomere attrition during this critical period could reflect the improved growth in the intervention group, rather than accumulated stress. Funding: The Bill and Melinda Gates Foundation.

Original languageEnglish (US)
JournaleLife
Volume6
DOIs
StatePublished - Oct 5 2017

Fingerprint

Hand Disinfection
Sanitation
Bangladesh
Telomere
Randomized Controlled Trials
Water
Nutrition
Base Pairing
Pregnant Women
Water treatment
Intention to Treat Analysis
Water Purification
Health

Keywords

  • child intervention
  • epidemiology
  • global health
  • human
  • low-income
  • nutrition
  • randomized controlled trial
  • telomere length
  • water, sanitation, hygiene

ASJC Scopus subject areas

  • Neuroscience(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)

Cite this

Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh. / Lin, Audrie; Arnold, Benjamin F.; Mertens, Andrew N.; Lin, Jue; Benjamin-Chung, Jade; Ali, Shahjahan; Hubbard, Alan E.; Stewart, Christine P.; Shoab, Abul K.; Rahman, Md Ziaur; Hossen, Md Saheen; Mutsuddi, Palash; Famida, Syeda L.; Akther, Salma; Rahman, Mahbubur; Unicomb, Leanne; Dhabhar, Firdaus; Fernald, Lia C.H.; Colford, John M.; Luby, Stephen P.

In: eLife, Vol. 6, 05.10.2017.

Research output: Contribution to journalArticle

Lin, A, Arnold, BF, Mertens, AN, Lin, J, Benjamin-Chung, J, Ali, S, Hubbard, AE, Stewart, CP, Shoab, AK, Rahman, MZ, Hossen, MS, Mutsuddi, P, Famida, SL, Akther, S, Rahman, M, Unicomb, L, Dhabhar, F, Fernald, LCH, Colford, JM & Luby, SP 2017, 'Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh', eLife, vol. 6. https://doi.org/10.7554/eLife.29365
Lin, Audrie ; Arnold, Benjamin F. ; Mertens, Andrew N. ; Lin, Jue ; Benjamin-Chung, Jade ; Ali, Shahjahan ; Hubbard, Alan E. ; Stewart, Christine P. ; Shoab, Abul K. ; Rahman, Md Ziaur ; Hossen, Md Saheen ; Mutsuddi, Palash ; Famida, Syeda L. ; Akther, Salma ; Rahman, Mahbubur ; Unicomb, Leanne ; Dhabhar, Firdaus ; Fernald, Lia C.H. ; Colford, John M. ; Luby, Stephen P. / Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh. In: eLife. 2017 ; Vol. 6.
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abstract = "Background: Shorter childhood telomere length (TL) and more rapid TL attrition are widely regarded as manifestations of stress. However, the potential effects of health interventions on child TL are unknown. We hypothesized that a water, sanitation, handwashing (WSH), and nutritional intervention would slow TL attrition during the first two years of life. Methods: In a trial in rural Bangladesh (ClinicalTrials.gov, NCT01590095), we randomized geographical clusters of pregnant women into individual water treatment, sanitation, handwashing, nutrition, combined WSH, combined nutrition plus WSH (N + WSH), or control arms. We conducted a substudy enrolling children from the control arm and the N + WSH intervention arm. Participants and outcome assessors were not masked; analyses were masked. Relative TL was measured at 1 and 2 years after intervention, and the change in relative TL was reported. Analysis was intention-to-treat. Findings: Between May 2012 and July 2013, in the overall trial, we randomized 720 geographical clusters of 5551 pregnant women to a control or an intervention arm. In this substudy, after 1 year of intervention, we assessed a total of 662 children (341 intervention and 321 control) and 713 children after 2 years of intervention (383 intervention and 330 control). Children in the intervention arm had significantly shorter relative TL compared with controls after 1 year of intervention (difference -163 base pairs (bp), p=0.001). Between years 1 and 2, TL increased in the intervention arm (+76 bp) and decreased in the controls (-23 bp) (p=0.050). After 2 years, there was no difference between the arms (p=0.305). Interpretation: Our unexpected finding of increased telomere attrition during the first year of life in the intervention group suggests that rapid telomere attrition during this critical period could reflect the improved growth in the intervention group, rather than accumulated stress. Funding: The Bill and Melinda Gates Foundation.",
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TY - JOUR

T1 - Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh

AU - Lin, Audrie

AU - Arnold, Benjamin F.

AU - Mertens, Andrew N.

AU - Lin, Jue

AU - Benjamin-Chung, Jade

AU - Ali, Shahjahan

AU - Hubbard, Alan E.

AU - Stewart, Christine P.

AU - Shoab, Abul K.

AU - Rahman, Md Ziaur

AU - Hossen, Md Saheen

AU - Mutsuddi, Palash

AU - Famida, Syeda L.

AU - Akther, Salma

AU - Rahman, Mahbubur

AU - Unicomb, Leanne

AU - Dhabhar, Firdaus

AU - Fernald, Lia C.H.

AU - Colford, John M.

AU - Luby, Stephen P.

PY - 2017/10/5

Y1 - 2017/10/5

N2 - Background: Shorter childhood telomere length (TL) and more rapid TL attrition are widely regarded as manifestations of stress. However, the potential effects of health interventions on child TL are unknown. We hypothesized that a water, sanitation, handwashing (WSH), and nutritional intervention would slow TL attrition during the first two years of life. Methods: In a trial in rural Bangladesh (ClinicalTrials.gov, NCT01590095), we randomized geographical clusters of pregnant women into individual water treatment, sanitation, handwashing, nutrition, combined WSH, combined nutrition plus WSH (N + WSH), or control arms. We conducted a substudy enrolling children from the control arm and the N + WSH intervention arm. Participants and outcome assessors were not masked; analyses were masked. Relative TL was measured at 1 and 2 years after intervention, and the change in relative TL was reported. Analysis was intention-to-treat. Findings: Between May 2012 and July 2013, in the overall trial, we randomized 720 geographical clusters of 5551 pregnant women to a control or an intervention arm. In this substudy, after 1 year of intervention, we assessed a total of 662 children (341 intervention and 321 control) and 713 children after 2 years of intervention (383 intervention and 330 control). Children in the intervention arm had significantly shorter relative TL compared with controls after 1 year of intervention (difference -163 base pairs (bp), p=0.001). Between years 1 and 2, TL increased in the intervention arm (+76 bp) and decreased in the controls (-23 bp) (p=0.050). After 2 years, there was no difference between the arms (p=0.305). Interpretation: Our unexpected finding of increased telomere attrition during the first year of life in the intervention group suggests that rapid telomere attrition during this critical period could reflect the improved growth in the intervention group, rather than accumulated stress. Funding: The Bill and Melinda Gates Foundation.

AB - Background: Shorter childhood telomere length (TL) and more rapid TL attrition are widely regarded as manifestations of stress. However, the potential effects of health interventions on child TL are unknown. We hypothesized that a water, sanitation, handwashing (WSH), and nutritional intervention would slow TL attrition during the first two years of life. Methods: In a trial in rural Bangladesh (ClinicalTrials.gov, NCT01590095), we randomized geographical clusters of pregnant women into individual water treatment, sanitation, handwashing, nutrition, combined WSH, combined nutrition plus WSH (N + WSH), or control arms. We conducted a substudy enrolling children from the control arm and the N + WSH intervention arm. Participants and outcome assessors were not masked; analyses were masked. Relative TL was measured at 1 and 2 years after intervention, and the change in relative TL was reported. Analysis was intention-to-treat. Findings: Between May 2012 and July 2013, in the overall trial, we randomized 720 geographical clusters of 5551 pregnant women to a control or an intervention arm. In this substudy, after 1 year of intervention, we assessed a total of 662 children (341 intervention and 321 control) and 713 children after 2 years of intervention (383 intervention and 330 control). Children in the intervention arm had significantly shorter relative TL compared with controls after 1 year of intervention (difference -163 base pairs (bp), p=0.001). Between years 1 and 2, TL increased in the intervention arm (+76 bp) and decreased in the controls (-23 bp) (p=0.050). After 2 years, there was no difference between the arms (p=0.305). Interpretation: Our unexpected finding of increased telomere attrition during the first year of life in the intervention group suggests that rapid telomere attrition during this critical period could reflect the improved growth in the intervention group, rather than accumulated stress. Funding: The Bill and Melinda Gates Foundation.

KW - child intervention

KW - epidemiology

KW - global health

KW - human

KW - low-income

KW - nutrition

KW - randomized controlled trial

KW - telomere length

KW - water, sanitation, hygiene

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