Linear Growth Under Age 2 May Improve Future Health Outcomes
Linear Growth Under Age 2 May Improve Future Health Outcomes
A new study demonstrates that improved birthweight and linear growth during the first 2 years of life among children from low- and middle-income countries is associated with protection against risk factors for chronic disease in adulthood as well as improvements in height and levels of schooling.
The study, by Linda S. Adair, PhD, from the University of North Carolina at Chapel Hill, and colleagues, will be published online March 28 in the Lancet.
Using prospective birth cohort data from 8362 participants from 5 countries (Brazil, Guatemala, India, the Philippines, and South Africa), researchers evaluated how health and educational outcomes such as body-mass index (BMI), systolic and diastolic blood pressure, plasma glucose concentration, height, and years of attained schooling relate to linear growth and weight gain during 3 age periods: 0-2 years, 2 years to mid-childhood, and mid-childhood to adulthood.
The researchers found that higher birthweight was consistently associated with decreased risk for dysglycemia (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.81 - 0.98), decreased likelihood of short adult stature (OR, 0.49; 95% CI, 0.44 - 0.54), and of not completing secondary school (OR, 0.82; 95% CI, 0.78 - 0.87). Rapid linear growth was also strongly associated with a reduced risk of not completing secondary school (age 2 years: OR, 0.74: 95% CI, 0.67 - 0.78; mid-childhood: OR, 0.87; 95% CI, 0.83 - 0.92) and less risk for short adult stature (age 2 years: OR, 0.23; 95% CI, 0.20 - 0.52; mid-childhood: OR, 0.39; 95% CI, 0.36 - 0.43).
Conversely, rapid weight gain after age 2 increased the likelihood of overweight (age 2 years: OR, 1.51; 95% CI, 1.43 - 1.60; mid-childhood: OR, 1.76; 95% CI, 1.69 - 1.91) and elevated blood pressure (age 2 years: OR, 1.07; 95% CI, 1.01 - 1.13; mid-childhood: OR, 1.22; 95% CI, 1.15 - 1.30).
The researchers acknowledge the heterogeneous nature of pooled data and that these associations do not prove causation. They note, however, that these results do support the idea that "[r]apid weight gain should not be promoted after the age of 2–3 years in children who are underweight but not wasted."
"Countries that are challenged by the dual burden of persistent undernutrition and emerging obesity need information about the many effects of early child growth, particularly during the important first 1000 days," write Dr. Adair and colleagues. "Traditional school feeding programmes that increase BMI with little effect on height might be doing more harm than good in terms of future health."
In an accompanying commentary, Zulfiqar A. Bhutta, MBBS, FRCP, PhD, from Aga Khan University, Karachi, Pakistan, notes that "Adair and colleagues' findings are some of the most important from existing cohorts linking early childhood nutrition — especially birthweight and improved patterns of linear growth — with long-term outcomes."
Although noting that these findings have specific implications for nutritional interventions and public health policy, Dr. Bhutta points out the lack of information about maternal nutrition and education, socioeconomic status, intrauterine growth retardation, or gestational age, which may also affect growth rates.
"Although the evidence emerging from observational studies such as Adair and colleagues' is important for policy, well designed prospective studies with appropriate interventions and follow-up are clearly needed," concludes Dr. Bhutta.
Funding for the study was provided by the Wellcome Trust and Bill & Melinda Gates Foundation. The authors and editorialist report no relevant financial relationships.
Lancet. Published online March 28, 2013. Abstract
A new study demonstrates that improved birthweight and linear growth during the first 2 years of life among children from low- and middle-income countries is associated with protection against risk factors for chronic disease in adulthood as well as improvements in height and levels of schooling.
The study, by Linda S. Adair, PhD, from the University of North Carolina at Chapel Hill, and colleagues, will be published online March 28 in the Lancet.
Using prospective birth cohort data from 8362 participants from 5 countries (Brazil, Guatemala, India, the Philippines, and South Africa), researchers evaluated how health and educational outcomes such as body-mass index (BMI), systolic and diastolic blood pressure, plasma glucose concentration, height, and years of attained schooling relate to linear growth and weight gain during 3 age periods: 0-2 years, 2 years to mid-childhood, and mid-childhood to adulthood.
The researchers found that higher birthweight was consistently associated with decreased risk for dysglycemia (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.81 - 0.98), decreased likelihood of short adult stature (OR, 0.49; 95% CI, 0.44 - 0.54), and of not completing secondary school (OR, 0.82; 95% CI, 0.78 - 0.87). Rapid linear growth was also strongly associated with a reduced risk of not completing secondary school (age 2 years: OR, 0.74: 95% CI, 0.67 - 0.78; mid-childhood: OR, 0.87; 95% CI, 0.83 - 0.92) and less risk for short adult stature (age 2 years: OR, 0.23; 95% CI, 0.20 - 0.52; mid-childhood: OR, 0.39; 95% CI, 0.36 - 0.43).
Conversely, rapid weight gain after age 2 increased the likelihood of overweight (age 2 years: OR, 1.51; 95% CI, 1.43 - 1.60; mid-childhood: OR, 1.76; 95% CI, 1.69 - 1.91) and elevated blood pressure (age 2 years: OR, 1.07; 95% CI, 1.01 - 1.13; mid-childhood: OR, 1.22; 95% CI, 1.15 - 1.30).
The researchers acknowledge the heterogeneous nature of pooled data and that these associations do not prove causation. They note, however, that these results do support the idea that "[r]apid weight gain should not be promoted after the age of 2–3 years in children who are underweight but not wasted."
"Countries that are challenged by the dual burden of persistent undernutrition and emerging obesity need information about the many effects of early child growth, particularly during the important first 1000 days," write Dr. Adair and colleagues. "Traditional school feeding programmes that increase BMI with little effect on height might be doing more harm than good in terms of future health."
In an accompanying commentary, Zulfiqar A. Bhutta, MBBS, FRCP, PhD, from Aga Khan University, Karachi, Pakistan, notes that "Adair and colleagues' findings are some of the most important from existing cohorts linking early childhood nutrition — especially birthweight and improved patterns of linear growth — with long-term outcomes."
Although noting that these findings have specific implications for nutritional interventions and public health policy, Dr. Bhutta points out the lack of information about maternal nutrition and education, socioeconomic status, intrauterine growth retardation, or gestational age, which may also affect growth rates.
"Although the evidence emerging from observational studies such as Adair and colleagues' is important for policy, well designed prospective studies with appropriate interventions and follow-up are clearly needed," concludes Dr. Bhutta.
Funding for the study was provided by the Wellcome Trust and Bill & Melinda Gates Foundation. The authors and editorialist report no relevant financial relationships.
Lancet. Published online March 28, 2013. Abstract
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