Differences in maternal and early child nutritional status by offspring sex in lowland Nepal

Saville, Naomi; Harris‐Fry, Helen; Marphatia, Akanksha A.; Reid, Alice; Cortina‐Borja, Mario; Manandhar, Dharma S; Wells, Jonathan C. K.

doi:10.1002/ajhb.23637

Cited by 8 publications

(6 citation statements)

References 47 publications

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“…Recent longitudinal evidence from Nepal [31] supports these ideas. An analysis of data from a randomised controlled trial explored differences in maternal and early child nutritional status by offspring sex.…”

Section: Maternal and Newborn Factorsmentioning

confidence: 89%

Understanding Sex Differences in Childhood Undernutrition: A Narrative Review

Thurstans

Opondo

Seal³

et al. 2022

Nutrients

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Complementing a recent systematic review and meta-analysis which showed that boys are more likely to be wasted, stunted, and underweight than girls, we conducted a narrative review to explore which early life mechanisms might underlie these sex differences. We addressed different themes, including maternal and newborn characteristics, immunology and endocrinology, evolutionary biology, care practices, and anthropometric indices to explore potential sources of sex differences in child undernutrition. Our review found that the evidence on why sex differences occur is limited but that a complex interaction of social, environmental, and genetic factors likely underlies these differences throughout the life cycle. Despite their bigger size at birth and during infancy, in conditions of food deprivation, boys experience more undernutrition from as early as the foetal period. Differences appear to be more pronounced in more severe presentations of undernutrition and in more socioeconomically deprived contexts. Boys are more vulnerable to infectious disease, and differing immune and endocrine systems appear to explain some of this disadvantage. Limited evidence also suggests that different sociological factors and care practices might exert influence and have the potential to exacerbate or reverse observed differences. Further research is needed to better understand sex differences in undernutrition and the implications of these for child outcomes and prevention and treatment programming.

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Section: Maternal and Newborn Factorsmentioning

confidence: 89%

Understanding Sex Differences in Childhood Undernutrition: A Narrative Review

Thurstans

Opondo

Seal³

et al. 2022

Nutrients

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“…Additional models (Models 2 and 3) then adjusted for potential confounders or mediating factors (maternal and paternal education; wealth tertile; caste; land ownership; study arm; randomization strata; and child sex). As previous analyses of this cohort have demonstrated associations of both sex and seasonality with neonatal and infant anthropometry (Saville et al, 2022a; Saville et al, 2022b), we adjusted for sex and season. Season of measurement was adjusted for by entering the terms “cosinor” harmonic terms in the models, where day of the year is quantified numerically along the scale 1–365 and 1–182.5, for annual and half‐yearly seasonality respectively.…”

Section: Methodsmentioning

confidence: 99%

Associations of maternal age at marriage and pregnancy with infant undernutrition: Evidence from first‐time mothers in rural lowland Nepal

Wells

Marphatia

Cortina‐Borja

et al. 2022

American Journal of Biological Anthropology

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Objectives: Maternal factors shape the risk of infant undernutrition, however the contributions of age at marriage versus age at pregnancy are rarely disentangled. We explore these issues in a population from lowland rural Nepal, where median ages at marriage and first pregnancy are 15 and 17 years respectively and marriage almost always precedes pregnancy. Methods:We analyzed data on first-time mothers (n = 3002) from a clusterrandomized trial (2012)(2013)(2014)(2015). Exposures were ages at marriage and pregnancy, categorized into groups. Outcomes were z-scores for weight (WAZ), length (LAZ), head circumference (HCAZ), and weight-for-length (WLZ), and prevalence of wasting and stunting, for neonates (<8 days) and infants (6-12 months). Mixed linear and logistic regression models tested associations of marriage and pregnancy ages with outcomes, adjusting for parental education, household assets, caste, landholding, seasonality, child sex, intervention arm, randomization strata and cluster.Results: For neonates, pregnancy <18 years predicted lower LAZ, and <19 years predicted lower WAZ and HCAZ. Results were largely null for marriage age, however early pregnancy and marriage at 10-13 years independently predicted neonatal stunting. For infants, earlier pregnancy was associated with lower LAZ and HCAZ, with a trend to lower WAZ for marriage 10-13 years. Early pregnancy, but not early marriage, predicted infant stunting.Conclusions: Early marriage and pregnancy were associated with poorer growth, mainly in terms of LAZ and HCAZ. Associations were stronger for neonatal than infant outcomes, suggesting pregnancy is more susceptible to these stresses. Early marriage and pregnancy may index different social and biological factors predicting child undernutrition.

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“…As well as the work discussed above that highlights high levels of being wasted and being stunted at birth, recent systematic reviews published by the WaSt TIG highlight population-level data that show that wasting, stunting, and being WaSt are all more prevalent in boys than girls, and that wasting is higher in younger children, while stunting is higher in older children ( 19 , 20 ). Possible explanatory factors for this are being explored ( 21 ). In the case of children with WaSt, the timing of peak prevalence appears between 12 and 30 months with younger children (≥12 and <24 months), with boys being more affected than girls.…”

Section: Lessons Learntmentioning

confidence: 99%

How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? Learnings from the Wasting and Stunting Project

Sadler¹,

James²,

Bhutta

et al. 2022

The Journal of Nutrition

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Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these conditions can share common risk factors and are often seen in the same child, they are commonly portrayed as relatively distinct manifestations of undernutrition. In 2014, the Wasting and Stunting project was launched by the Emergency Nutrition Network. Its aim was to better understand the complex relationship and associations between wasting and stunting and examine whether current separations that were apparent in approaches to policy, financing, and programs were justified or useful. Based on the project's work, this article aims to bring a wasting and stunting lens to how research is designed and financed in order for the nutrition community to better understand, prevent, and treat child undernutrition. Discussion of lessons learnt focuses on the synergy and temporal relationships between children's weight loss and linear growth faltering, the proximal and distal factors that drive diverse forms of undernutrition, and identifying and targeting people most at risk. Supporting progress in all these areas requires research collaborations across interest groups that highlight the value of research that moves beyond a focus on single forms of undernutrition, and ensures that there is equal attention given to wasting as to other forms of malnutrition, wherever it is present.

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Differences in maternal and early child nutritional status by offspring sex in lowland Nepal

Cited by 8 publications

References 47 publications

Understanding Sex Differences in Childhood Undernutrition: A Narrative Review

Understanding Sex Differences in Childhood Undernutrition: A Narrative Review

Associations of maternal age at marriage and pregnancy with infant undernutrition: Evidence from first‐time mothers in rural lowland Nepal

How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? Learnings from the Wasting and Stunting Project

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