Effect of pesticide exposure on stunting incidence: a systematic review and meta-analysis

As an endocrine disruptor chemical, pesticide exposure may affect the regulation of growth hormones such as insulin-like growth factor-1 (IGF-1). A few current studies to date have noted that long-term pesticide exposure disrupted IGF-1, a potential risk of stunting in children. This study aims to evaluate studies to date of the effect of pesticide exposure on stunting incidence. This systematic review and meta-analysis adhered to the PRISMA (Pre-ferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. The PubMed and EBSCO databases were searched for relevant articles without publication restrictions. This review aimed to include reviews, randomized controlled trials (RCT), and cohort, case-control, and cross-sectional studies, which provide actual exposure types of pesticides with stunting measurement by height-age z score. A screening, extraction, and synthesis were conducted, leading to a consensus for reaching mutual agreement. The analysis was performed using Microsoft Excel 2017 for the screening and extraction, Revman version 5.4 software for the meta-analysis, and OpenMEE software for the meta-regression. Of the 13 studies subjected to the qualitative analysis, 6 were eligible for inclusion in the meta-analysis: 2 reviews, 2 RCTs, 2 cohorts, 2 case-control, and 5 cross-sectional studies. Exposure to organophosphate and pyrethroid pesticides was not associated with stunting (P=0.78; odds ratio [OR], 1.11; 95% confidence interval [CI], 0.65-1.88). Heterogeneity existed for 79% of the meta-analysis (P≤0.000; z=-5.37; 95% CI, -0.034 to -0.016), and the meta-regression identified age as the causative covariate. Pesticide exposure, regardless of type, is not associated with stunting in children.