Lead Exposure and Nutritional Status Among Bangladeshi Children: An Analysis Based on Bangladesh Multiple Indicator Cluster Survey

Bangladesh carries one of the world’s highest estimated childhood lead burdens alongside a substantial undernutrition burden, yet no nationally representative study has examined the association of blood lead levels (BLLs) with anthropometric failure. We analysed data from the 2025 Bangladesh Multiple Indicator Cluster Survey, including 10,495 children aged 12–59 months with BLLs and anthropometric measurements. Venous blood lead, arsenic, cadmium, and mercury were measured alongside anthropometry. Associations of BLLs with height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z-scores were estimated using linear regression; associations with stunting, wasting, underweight, and the Composite Index of Anthropometric Failure (CIAF, comprising six disaggregated failure categories) were estimated using modified Poisson regression yielding adjusted prevalence ratios (APRs). Models considered continuous standardised log-transformed BLLs and elevated BLLs (≥5 µg/dL), with and without adjustment for arsenic, cadmium, mercury, and covariates. The prevalence of stunting, wasting, underweight, and CIAF was 25.9%, 14.1%, 26.5%, and 38.2%, respectively. Elevated BLL (≥5 µg/dL) prevalence was 38.6%. Higher BLLs were significantly associated with lower HAZ (β = −0.075), WAZ (β = −0.062), and WHZ (β = −0.029) and with higher prevalence of stunting (APR = 1.09), wasting (APR = 1.08), underweight (APR = 1.08), and CIAF (APR = 1.07); estimates were similar after mutual adjustment for arsenic, cadmium, and mercury. Elevated BLLs (≥5 µg/dL) were not significantly associated with WHZ. BLLs were associated with several CIAF patterns, most strongly the combined stunting-wasting-underweight category (APR = 1.18), with significant associations present across every category involving stunting. In exploratory analyses, elevated BLLs were significantly associated with household soil lead concentration (APR = 1.22), occupational contact with lead-related work (APR = 1.08), and child pica behaviour (APR = 1.18), and were inversely associated with solid fuel use for cooking (APR = 0.78). Elevated BLL prevalence varied substantially by district (range 4.4–93.7%), with higher burden concentrated in the central–eastern region. BLLs were associated with impaired growth and specific patterns of anthropometric failure among Bangladeshi children. These findings support prioritising lead source control and integrating growth monitoring with environmental exposure surveillance in national child health programmes. Household soil lead, occupational exposure, and child pica behaviour represent modifiable targets for source-control interventions.