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

Christian, P., Lee, S. E., Donahue Angel, M., Adair, L. S., Arifeen, S. E., Ashorn, P., Barros, F. C., Fall, C. H., Fawzi, W. W., Hao, W., Hu, G., Humphrey, J. H., Huybregts, L., Joglekar, C. V., Kariuki, S. K., Kolsteren, P., Krishnaveni, G. V., Liu, E., Martorell, R., Osrin, D., Persson, L.-A., Ramakrishnan, U., Richter, L., Roberfroid, D., Sania, A., terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617, Tielsch, J., Victora, C. G., Yajnik, C. S., Yan, H., Zeng, L. and Black, R. E. (2013) 'Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries'. International Journal of Epidemiology, Vol 42, Issue 5, pp. 1340-1355.

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Abstract

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.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WS Pediatrics > Child Care. Nutrition. Physical Examination > WS 115 Nutritional requirements. Nutrition disorders
WS Pediatrics > Child Care. Nutrition. Physical Examination > WS 130 In childhood
WS Pediatrics > By Age Groups > WS 410 Premature infants. Diseases of premature infants
WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
WS Pediatrics > By Age Groups > WS 430 Infancy
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1093/ije/dyt109
Depositing User: Martin Chapman
Date Deposited: 17 Mar 2014 12:49
Last Modified: 31 May 2018 13:42
URI: http://archive.lstmed.ac.uk/id/eprint/3615

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