Growth patterns in early childhood and final attained stature: Data from five birth cohorts from low‐ and middle‐income countries

Abstract

Growth failure is cumulative, and short stature is associated with multiple indices of reduced human capital. Few studies have been able to address in a single analysis both consideration of the timing of growth failure and comparison across populations. We analyzed data from birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa (n = 4,659). We used data on length at birth (available for three of the five cohorts), 12 mo, 24 mo, and mid-childhood to construct cohort- and sex- specific conditional length measures. We modeled adult height as a function of conditional length in childhood. The five cohorts experienced varying degrees of growth failure. As adults, the Brazil sample was 0.35 ± 0.89 standard deviations (SD) below the World Health Organization reference, while adult Guatemalans were 1.91 ± 0.87 SD below the reference. All five cohorts experienced a nadir in height for age Z-score at 24 mo. Birth length (in the three cohorts with this variable), and conditional length at 12 mo (in all five cohorts) were the most strongly associated with adult height. Growth in the periods 12–24 mo and 24 mo to mid-childhood showed inconsistent patterns across tertiles of adult height. Despite variation in the magnitude of cumulative growth failure across cohorts, the five cohorts show highly consistent age-specific associations with adult stature. Growth failure prior to age 12 mo was most strongly associated with adult stature. These consistencies speak to the importance of interventions to address intrauterine growth failure and growth failure in the first 12 mo of life. Am. J. Hum. Biol. 2010. © 2009 Wiley-Liss, Inc.

Determinants of relative skeletal maturity in South African children

“…Rapid weight gain in infancy (an increase in weight-for-age of greater than 0.67 Z scores between birth and 2 years [24]) was associated with greater skeletal maturity at age 9 years in both cohorts, despite their differing environments, with skeletal maturity advanced by the same magnitude in both settings; approximately 2.4 months per standard deviation score increase in weight from 0-2 years [13]. The conditional weight measure used here at 2 years, while not necessarily representing 'clinically significant' rapid infant weight gain, does represent the extent to which a child's rate of growth deviates from the rate predicted based on the individuals birthweight [14]. The finding that greater conditional weight at 2 years is positively associated with RSM at 9/10 years indicates that it is the tempo of growth in the first two years, rather than absolute weight at 2 years, which influences the rate of skeletal maturation.…”

“…Separate models were built for each dimension of growth in order to ascertain the independent effects of weight and height on RSM, and also the effect of weight adjusted for height (BMI). To avoid the statistical issues associated with collinearity between measures at multiple time points within the same individual, conditional weight, height, and BMI variables at 2, 4 and 9/10 years were created to represent each individual's size given their previous size(s) [14]. Conditional measures represent the residuals from sex-specific regressions of weight Z-score (or length/BMI) on weight Zscores (or length/BMI) at all previous ages.…”

Evidence of Impact of Interventions on Growth and Development during Early and Middle Childhood

“…Worldwide patterns of linear growth faltering, based on data from many low-and middle-income countries (LMICs) (Victora and others 2010), indicate deterioration of child nutritional status, on average, from age 0 to 24 months; after this period, nutritional status levels off or slightly reverses (for example, Prentice and others 2013;Stein and others 2010). Analyses of the five countries in the Consortium of Health-Orientated Research in Transitioning Societies (COHORTS) study found that low birth weight or undernutrition at age two years (or both) were associated with shorter adult height, less schooling, and lower economic productivity (Victora and others 2008).…”

Linear Growth and Child Development in Burkina Faso, Ghana, and Malawi

“…1,2 Brain development occurs rapidly during this same period, from conception to age 2 years, laying the foundation for the development of cognitive, motor, and socioemotional skills throughout childhood and adulthood. The extent to which children globally are faltering in the development of these abilities during the first 2 years of life is less clear.…”