Parental tobacco use is associated with increased risk of child malnutrition in Bangladesh

OBJECTIVES: We investigated the relation between parental tobacco use and malnutrition in children <5 y of age and compared expenditures on foods in households with and without tobacco use. METHODS: Tobacco use, child anthropometry, and other factors were examined in a stratified, multistage cluster sample of 77 678 households from the Bangladesh Nutrition Surveillance Project (2005-2006). Main outcome measurements were stunting, underweight, and wasting, and severe stunting, severe underweight, and severe wasting. Secondary outcomes included the proportion of household expenditures spent on food. RESULTS: The prevalence of parental tobacco use was 69.9%. Using the new World Health Organization child growth standards, prevalences of stunting, underweight, and wasting were 46.0%, 37.6%, and 12.3%, respectively. After adjusting for potential confounders, parental tobacco use was associated with an increased risk of stunting (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.12-1.21, P < 0.0001), underweight (OR 1.17, 95% CI 1.12-1.22, P < 0.0001), and wasting (OR 1.10, 95% CI 1.03-1.17, P = 0.004), and severe stunting (OR 1.16, 95% CI 1.10-1.23, P < 0.0001), severe underweight (OR 1.21, 95% CI 1.13-1.30, P < 0.0001), and severe wasting (OR 1.14, 95% CI 0.98-1.32, P = 0.09). Households with tobacco use spent proportionately less per capita on food items and other necessities. CONCLUSIONS: In Bangladesh parental tobacco use may exacerbate child malnutrition and divert household funds away from food and other necessities. Further studies with a stronger analytic approach are needed. These results suggest that tobacco control should be part of public health strategies aimed at decreasing child malnutrition in developing countries.