Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Jade Benjamin-Chung
Department of Epidemiology & Population Health, Stanford University, Stanford, United States
Abul K Shoab
Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Md Ziaur Rahman
Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Syeda L Famida
Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Md Saheen Hossen
Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Palash Mutsuddi
Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Salma Akther
Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Mahbubur Rahman
Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Leanne Unicomb
Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Ruchira Tabassum Naved
Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Md Mahfuz Al Mamun
Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Kausar Parvin
Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Firdaus S Dhabhar
Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, United States
Patricia Kariger
Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, United States
Lia CH Fernald
Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, United States
Stephen P Luby
Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, United States
John M Colford Jr
Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, United States
Background: Previously, we demonstrated that a water, sanitation, handwashing, and nutritional intervention improved linear growth and was unexpectedly associated with shortened childhood telomere length (TL) (Lin et al., 2017). Here, we assessed the association between TL and growth. Methods: We measured relative TL in whole blood from 713 children. We reported differences between the 10th percentile and 90th percentile of TL or change in TL distribution using generalized additive models, adjusted for potential confounders. Results: In cross-sectional analyses, long TL was associated with a higher length-for-age Z score at age 1 year (0.23 SD adjusted difference in length-for-age Z score [95% CI 0.05, 0.42; FDR-corrected p-value = 0.01]). TL was not associated with other outcomes. Conclusions: Consistent with the metabolic telomere attrition hypothesis, our previous trial findings support an adaptive role for telomere attrition, whereby active TL regulation is employed as a strategy to address ‘emergency states’ with increased energy requirements such as rapid growth during the first year of life. Although short periods of active telomere attrition may be essential to promote growth, this study suggests that a longer overall initial TL setting in the first 2 years of life could signal increased resilience against future telomere erosion events and healthy growth trajectories. Funding: Funded by the Bill and Melinda Gates Foundation. Clinical trial number: NCT01590095