Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries

Bibliographic Data

ID23345709
AuthorsPolly Christian (0000-0002-2908-1030, Universidade Católica de Pelotas, corresponding author), Parul Christian, Sun Eun Lee (0000-0002-1983-4561), Moira Donahue Angel (0000-0002-9732-3329), Linda S Adair (0000-0002-3670-8073), Shams El Arifeen (0000-0002-5372-5932), Shams E Arifeen, Per Ashorn (0000-0003-2311-2593), Fernando C Barros (0000-0001-5973-1746), Caroline Fall (0000-0003-4402-5552), Caroline HD Fall, Wafaie W Fawzi (0000-0002-2908-600X), Wei Hao (0000-0001-9493-6894), Gang Hu (0000-0002-7892-5578), Jean H Humphrey (0000-0001-6974-2975), Lieven Huybregts (0000-0002-3068-2853), Charu V Joglekar, Simon Kariuki (0000-0003-0554-1976), Simon K Kariuki, Patrick Kolsteren (0000-0002-0504-2205), Ghattu V Krishnaveni (0000-0002-6532-8272), Enqing Liu (0000-0002-4189-8182), Reynaldo Martorell (0000-0001-8862-7243), David Osrin (0000-0001-9691-9684), Lars Ake Persson (0000-0003-0710-7954), Lars-Åke Persson, Usha Ramakrishnan (0000-0003-1694-1238), L M Richter (0000-0002-3654-3192), Linda Richter (0000-0001-8029-2880), Dominique Roberfroid (0000-0003-3881-5558), Ayesha Sania (0000-0002-6445-9481), Feiko O ter Kuile (0000-0003-3663-5617), James M Tielsch (0000-0002-1151-060X), James Tielsch, Cesar G Victora (0000-0002-2465-2180), Chittaranjan S Yajnik (0000-0002-2911-2378), Hong Yan (0000-0003-3360-5543), Lingxia Zeng (0000-0002-4649-9818), Robert E Black (0000-0001-9926-7984)
Year2013
Volume42
Issue5
Pages1340-1355
Publication date2013-10-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueInternational Journal of Epidemiology (JOURNAL)
Journal identifiersISSN: 0300-5771 • E-ISSN: 1464-3685
PublisherOxford University Press (OUP) (PUBLISHER)
DOI10.1093/ije/dyt109
PMID23920141
PMCIDPMC3816349
OpenAlexW2168268121
LanguageEN
Citations received85
References cited47

BACKGROUND: Low- and middle-income countries continue 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.

Developing country · Economic growth · Economics · Environmental health · Gestational age · Low and middle income countries · Malnutrition · Obstetrics · Pregnancy · Premature birth · Small for gestational age · Birth, Development, and Health · Child Nutrition and Water Access · Demography · Global Maternal and Child Health · Medicine · Pediatrics