Catch up growth in low birth weight infants: Striking a healthy balance

Abstract

Catch-up growth in the first few months of life is seen almost ubiquitously in infants born small for their gestational age and conventionally considered highly desirable as it erases the growth deficit. However, recently such growth has been linked to an increased risk of later adiposity, insulin resistance and cardiovascular disease in both low income and high-income countries. In India, a third of all babies are born with a low birth weight, but the optimal growth pattern for such infants is uncertain. As a response to the high rates of infectious morbidities, undernutrition and stunting in children, the current policy is to promote rapid growth in infancy. However, with socio-economic transition and urbanization making the Indian environment more obesogenic, and the increasing prevalence of type 2 diabetes and cardiovascular disease, affecting progressively younger population, the long term adverse programming effect of fast/excessive weight gain in infancy on later body composition and metabolism may outweigh short-term benefits. This review discusses the above issues focusing on the need to strike a healthy balance between the risks and benefits of catch-up growth in Indian infants.

Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease

“…Acknowledgement of this paradigm is important because interventions to optimize fetal and child health as strategies to prevent adult NCDs have great potential economic, societal and individual benefit 4 . Many developing countries carry the dual burdens of under-and overnutrition contributing to the vicious cycles of poor maternal health, suboptimal fetal development and unhealthy childhood growth which all augment the risk of adult disease 5,6 . In this manuscript we will describe how fetal and child health impact kidney development and risk of disease, focusing mainly on human studies, but utilizing animal data where necessary to provide more insight.…”

“…"Catch-up" growth in children who had been of LBW has long been advocated especially in developing countries, improving an infant's resilience against infections and reducing the risk of undernutrition, stunting and cognitive impairment 5 . Increasingly, however, in many populations world-wide, accelerated weight gain or increase in BMI, even in children with NBW, has been consistently associated with increased risk of adult hypertension, type 2 diabetes, and cardiovascular disease [76][77][78] .…”

“…LBW children in an environment of adequate nutrient supply tend to experience rapid weight gain 5 . Among 22-year-old British subjects, systolic blood pressure was 1.3 mmHg (95% CI, 0.3 -2.3 mmHg) higher for every standard deviation decrease in birth weight, and increased by 1.6 mmHg (95% CI, 0.6 -2.7 mmHg) for every standard deviation increase in childhood weight gain between 1 and 10 years 81 .…”

Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations

“…For example, while prevention of stunting and promotion of linear growth clearly has long-term benefits for health and human capital [13], faster weight gain in infancy is also associated with a greater risk of obesity and hence NCDs [14]. Therefore, for one population the intervention may be more centred on promoting infant linear growth with less concern around faster weight gain, while in another population and context minimising excessive infant weight gain may be more relevant to offset risk in later life [15]. Also, as the levers to foster healthy nutritional practices and patterns of growth in infancy may vary due to cultural practices and context, more multi-site studies that take into account population and cultural variation within and between African countries could be particularly helpful to elucidate pathways to impact [16,17].…”

Endocrine and metabolic diurnal rhythms in young adult men born small vs appropriate for gestational age

“…Indeed, SGA subjects commonly display increased catch-up growth early in life, and increased catch-up growth per se has been proposed as an independent risk factor of cardiometabolic diseases including T2D later in life (52).…”