TY - JOUR
T1 - Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries
AU - Christian, Parul
AU - Lee, Sun Eun
AU - Angel, Moira Donahue
AU - Adair, Linda S.
AU - Arifeen, Shams E.
AU - Ashorn, Per
AU - Barros, Fernando C.
AU - Fall, Caroline H.D.
AU - Fawzi, Wafaie W.
AU - Hao, Wei
AU - Hu, Gang
AU - Humphrey, Jean H.
AU - Huybregts, Lieven
AU - Joglekar, Charu V.
AU - Kariuki, Simon K.
AU - Kolsteren, Patrick
AU - Krishnaveni, Ghattu V.
AU - Liu, Enqing
AU - Martorell, Reynaldo
AU - Osrin, David
AU - Persson, Lars Ake
AU - Ramakrishnan, Usha
AU - Richter, Linda
AU - Roberfroid, Dominique
AU - Sania, Ayesha
AU - Kuile, Feiko O.Ter
AU - Tielsch, James
AU - Victora, Cesar G.
AU - Yajnik, Chittaranjan S.
AU - Yan, Hong
AU - Zeng, Lingxia
AU - Black, Robert E.
N1 - Funding Information:
This analytical work was supported by the Bill and Melinda Gates Foundation [810-2054], Seattle, Washington, USA, to the US Fund for UNICEF to support the work of the Child Health Epidemiology Reference Group. Financial support for analysis was offered to investigators (CV, JH) through a subcontract mechanism administered by the US Fund for UNICEF.
PY - 2013/10
Y1 - 2013/10
N2 - Background Low- a nd middle-income countriescontinue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30-40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain. Methods Using extant longitudinal birth cohorts (n=19) with data on birthweight, gestational age and child anthropometry (12-60 months), we estimated study-specific and pooled risk estimates of stunting, wasting and underweight by small-for-gestational age (SGA) and preterm birth. Results We grouped children according to four combinations of SGA and gestational age: adequate size-for-gestational age (AGA) and preterm; SGA and term; SGA and preterm; and AGA and term (the reference group). Relative to AGA and term, the OR (95% confidence interval) for stunting associated with AGA and preterm, SGA and term, and SGA and preterm was 1.93 (1.71, 2.18), 2.43 (2.22, 2.66) and 4.51 (3.42, 5.93), respectively. A similar magnitude of risk was also observed for wasting and underweight. Low birthweight was associated with 2.5-3.5-fold higher odds of wasting, stunting and underweight. The population attributable risk for overall SGA for outcomes of childhood stunting and wasting was 20% and 30%, respectively. Conclusions This analysis estimates that childhood undernutrition may have its origins in the foetal period, suggesting a need to intervene early, ideally during pregnancy, with interventions known to reduce FGR and preterm birth.
AB - Background Low- a nd middle-income countriescontinue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30-40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain. Methods Using extant longitudinal birth cohorts (n=19) with data on birthweight, gestational age and child anthropometry (12-60 months), we estimated study-specific and pooled risk estimates of stunting, wasting and underweight by small-for-gestational age (SGA) and preterm birth. Results We grouped children according to four combinations of SGA and gestational age: adequate size-for-gestational age (AGA) and preterm; SGA and term; SGA and preterm; and AGA and term (the reference group). Relative to AGA and term, the OR (95% confidence interval) for stunting associated with AGA and preterm, SGA and term, and SGA and preterm was 1.93 (1.71, 2.18), 2.43 (2.22, 2.66) and 4.51 (3.42, 5.93), respectively. A similar magnitude of risk was also observed for wasting and underweight. Low birthweight was associated with 2.5-3.5-fold higher odds of wasting, stunting and underweight. The population attributable risk for overall SGA for outcomes of childhood stunting and wasting was 20% and 30%, respectively. Conclusions This analysis estimates that childhood undernutrition may have its origins in the foetal period, suggesting a need to intervene early, ideally during pregnancy, with interventions known to reduce FGR and preterm birth.
KW - Childhood
KW - Foetal growth restriction
KW - Preterm birth
KW - Stunting
KW - Wasting
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U2 - 10.1093/ije/dyt109
DO - 10.1093/ije/dyt109
M3 - Article
C2 - 23920141
AN - SCOPUS:84886395017
SN - 0300-5771
VL - 42
SP - 1340
EP - 1355
JO - International journal of epidemiology
JF - International journal of epidemiology
IS - 5
M1 - dyt109
ER -