Determinants of nutritional status during the first 1000 days of life in Lebanon: Sex of the child matters

Abstract

Background:The first 1000 days of life support child growth and long-term health, but few studies address this period in Lebanon and the Eastern Mediterranean Region.Objective: To examine the determinants of nutritional status among Lebanese children ≤2 years old by child's sex. Methods:We analysed data from a nationally representative cross-sectional survey of 466 mother-child dyads. We classified socio-economic, maternal, and child characteristics using a hierarchical conceptual framework into distal, intermediate, and proximal levels, respectively. Sex-stratified weighted multiple linear regression was computed to identify the determinants of length-for-age z-scores (LAZ) and weightfor-length z-scores (WLZ). Results:The mean (standard deviation) of LAZ and WLZ was −0.3 (1.6) and 0.5 (1.5) among boys and −0.1 (1.4) and 0.5 (1.0) among girls, respectively. At the distal level, maternal intermediate or high school education was associated with higher boys' LAZ (β 1.0, 95% confidence interval (CI) 0.2, 1.8), and less crowded households were associated with higher girls' LAZ (β 0.8, 95% CI 0.3, 1.4). At the intermediate level, maternal obesity was associated with lower girls' LAZ (β −0.9, 95% CI −1.4, −0.4). At the proximal level, birth length directly (β 0.1, 95% CI 0.0, 0.2) and breast-feeding duration inversely (β −0.1, 95% CI −0.1, −0.0) associated with girls' LAZ. For WLZ, paternal attainment of university degree or technical diploma was associated with lower boys' WLZ (β −0.9, 95% CI −1.8, −0.1). Among the proximal determinants, birthweight was directly associated with boys' WLZ (β 1.2, 95% CI 0.6, 1.8), while being a third or later child was associated with lower girls' WLZ (β −0.5, 95% CI −0.8, −0.2). Child age was directly associated with WLZ among boys and girls (β 0.1, 95% CI 0.0, 0.1). Conclusions:Nutritional status determinants differed by child's sex in Lebanon.These findings may help inform interventions to improve child growth.

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

“…We find few sex differences in the anthropometry of Yucatec Maya children, which contrasts with some work showing sex differences in nutritional status (Akombi et al, 2017; Chehab et al, 2021; Cordero & Cesani, 2019; Shah et al, 2020). It is, however, consistent with some studies and observations that Yucatec Maya parents generally do not invest preferentially in their children based on sex (Ahsan et al, 2020; Kramer et al, 2016).…”

Infant and young child feeding practices in Lebanon: a cross-sectional national study

“…The first '1000 days' of life, which cover the period between conception and the child's second birthday, is characterised by high plasticity and rapid development of organs and systems, including the brain, immune and neural systems as well as the gut microbiome (1) . As such, this period of the lifecycle represents a unique window of opportunity to shape growth and lay the foundations for optimal health and development (2) .…”