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Lee GO, McCormick BJ, Yori PP, Paredes-Olortegui M, Caulfield LE, Kosek MN. Short-term dynamics of linear growth among Peruvian infants in the first year of life in a population with linear growth faltering. Am J Hum Biol 2024; 36:e24039. [PMID: 38189589 PMCID: PMC11144106 DOI: 10.1002/ajhb.24039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVES Infant growth is recognized to vary over the short term, with periods of greater and lesser linear growth velocity. Our objectives were to (1) examine the potential differences in overall growth profiles between children who experienced cumulative growth faltering in the first year of life consistent with that seen by many children living in poverty in low- and middle-income countries, versus children without growth faltering and (2) test whether biological factors were associated with the timing of magnitude of growth saltations. METHODS Thrice-weekly measurements of length were recorded for n = 61 Peruvian infants (28 boys and 33 girls) enrolled from birth to 1 year. A total of 6040 measurements were analyzed. We tested for the evidence of saltatory growth and used hurdle models to test whether the timing and magnitude of saltations varied between children with greater or lesser growth faltering. RESULTS There were no differences in the duration of stasis periods or magnitude of growth saltations between children who were stunted at 1 year old (N = 18) versus those who were not stunted (N = 43). Children who experienced greater declines in LAZ in the first year of life trended toward longer periods between saltations than those with less of a decline (14.5 days vs. 13.4 days, p = .0512). A 1-unit increase in mid upper arm circumference for age Z-score in the 21 days prior was associated with 35% greater odds of a saltation occurring (p < .001), and a 0.128 cm greater saltation (p < .001). CONCLUSIONS After characterizing infant growth into periods of saltation and stasis, our results suggest that increases in weight preceded increases in length.
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Affiliation(s)
- Gwenyth O. Lee
- Rutgers Global Health Institute and Department of Epidemiology and Biostatistics, Rutgers University, New Brunswick, New Jersey, USA
| | | | - Pablo P. Yori
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | - Laura E. Caulfield
- Center for Human Nutrition, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Margaret N. Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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Nicholas JL, Douglas KE, Waters W, Gallegos Riofrío CA, Chapnick M, Habif DV, True S, Musonza C, Iannotti L. US Evaluation of Bone Age in Rural Ecuadorian Children: Association with Anthropometry and Nutrition. Radiology 2020; 296:161-169. [PMID: 32343211 DOI: 10.1148/radiol.2020190606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Stunted growth and development is a serious global public health problem. A limited number of field measures exist that can be used to evaluate stunting and its underlying biologic mechanisms. Purpose To assess bone age using tablet-based US in young children living in a rural community in Ecuador, where stunting is prevalent, and to evaluate the associations between bone age, anthropometry, and diet. Materials and Methods From June through August 2017, tablet-based US was used to assess bone age in young children within their homes in rural Cotopaxi, Ecuador. Bone age z scores (BAZs) were assigned using the standards of Greulich and Pyle. Anthropometric data were collected using international protocols; z scores were generated from World Health Organization Child Growth Standards. Groups were compared using the Student t test. Univariate analyses and generalized linear regression modeling were applied to test the association between bone age and anthropometry, adjusting for covariates including age, sex, dietary intake, and morbidities. Results A total of 128 children (mean age, 33.9 months ± 1.8 [standard deviation]; 59 girls, 69 boys) were evaluated. Mean BAZ was -1.20 ± 1.16. Mean BAZ was lower in children with stunted growth (-1.42 ± 1.18) than in children without stunted growth (-0.98 ± 1.10, P = .04). In adjusted analysis, BAZ was associated with the following variables: height-for-age z score (β coefficient, 0.26; 95% confidence interval [CI]: 0.05, 0.46; P = .01), female sex (β coefficient, 0.51; 95% CI: 0.15, 0.88; P = .006), number of times eggs were consumed in the previous 24 hours (β coefficient, 0.22; 95% CI: 0.05, 0.38; P = .009), number of times savory or salty snacks were consumed in the previous 24 hours (β coefficient, 0.42; 95% CI: 0.15, 0.68; P = .002), and ownership of pig livestock, which was a binary variable (β coefficient, -0.46; 95% CI: -0.82, -0.09; P = .01). Conclusion Bone age determined using tablet-based US was lower in children who had stunted growth and was associated with diet in a cohort of children living in rural Ecuador. © RSNA, 2020 See also the editorial by Dillman and Ayyala in this issue.
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Affiliation(s)
- Jennifer L Nicholas
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
| | - Katherine E Douglas
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
| | - William Waters
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
| | - Carlos Andres Gallegos Riofrío
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
| | - Melissa Chapnick
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
| | - David V Habif
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
| | - Sarah True
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
| | - Clive Musonza
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
| | - Lora Iannotti
- From the Mallinckrodt Institute of Radiology-Pediatric Radiology, Washington University School of Medicine, St Louis, Mo (J.L.N., K.E.D.); Colegio de Ciencias de la Salud, Universidad de San Francisco de Quito, Quito, Ecuador (W.W.); and Brown School of Social Work and Public Health, Washington University, St Louis, Mo (C.A.G.R., M.C., D.V.H., S.T., C.M., L.I.)
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Schwinger C, Fadnes LT, Shrestha SK, Shrestha PS, Chandyo RK, Shrestha B, Ulak M, Bodhidatta L, Mason C, Strand TA. Predicting Undernutrition at Age 2 Years with Early Attained Weight and Length Compared with Weight and Length Velocity. J Pediatr 2017; 182:127-132.e1. [PMID: 27974166 PMCID: PMC5323241 DOI: 10.1016/j.jpeds.2016.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/12/2016] [Accepted: 11/03/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the abilities of weight and length velocities vs attained growth measures to predict stunting, wasting, and underweight at age 2 years. STUDY DESIGN We analyzed data from a community-based cohort study (The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development study [MAL-ED] study) in Bhaktapur, Nepal. A total of 240 randomly selected children were enrolled at birth and followed up monthly up to age 24 months. Linear and logistic regression models were used to predict malnutrition at 2 years of age with growth velocity z scores at 0-3, 0-6, 3-6, 6-9, 6-12, and 9-12 months (using the World Health Organization Growth Standards) or attained growth at 0, 3, 6, and 12 months as predictors. RESULTS At age 2 years, 4% of the children were wasted, 13% underweight, and 21% stunted. Children who were malnourished at age 2 years had lower mean growth z scores already at birth and throughout the study period. Anthropometric indicators in infancy were significant predictors for growth at the age of 2 years during most periods and at most ages in infancy. Weight-for-age z score, length-for-age z score, and weight-for-length z score at age 12 months had excellent areas under the curve (91-95) to predict the value of the same indicator at age 24 months. Maximum area under the curve values for weight and length velocity were somewhat lower (70-84). CONCLUSIONS Growth measured at one time point in infancy was better correlated with undernutrition at age 2 years than growth velocity.
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Affiliation(s)
- Catherine Schwinger
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Lars T Fadnes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Sanjaya K Shrestha
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences, Kathmandu, Nepal
| | | | - Ram Krishna Chandyo
- Department of Child Health, Institute of Medicine, Tribuhvan University, Kathmandu, Nepal
| | - Binob Shrestha
- Research Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences, Kathmandu, Nepal
| | - Manjeswori Ulak
- Department of Child Health, Institute of Medicine, Tribuhvan University, Kathmandu, Nepal
| | - Ladaporn Bodhidatta
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Carl Mason
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Tor A Strand
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
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