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Factors associated with catch-up growth in early infancy in rural Pakistan: A longitudinal analysis of the women's work and nutrition study.

ABSTRACT: The adverse health impacts of early infant stunting can be partially ameliorated by early catch-up growth. Few studies have examined predictors of and barriers to catch-up growth to identify intervention points for improving linear growth during infancy. This study aimed to estimate the prevalence of, and factors associated with, catch-up growth among infants in Pakistan. A longitudinal study of mother-infant dyads (n = 1,161) was conducted in rural Sindh province, with enrolment between December 2015 and February 2016 (infants aged 0.5-3 months), and follow-up (n = 1035) between November 2016 and January 2017 (infants aged 9-15 months). The outcome was catch-up growth (change in conditional length-for-age z-scores >0.67 between baseline and endline). Associated factors were examined using multivariable logistic regression analyses. The prevalence of stunting was 45.3% at baseline and 60.7% at follow-up. 22.8% of infants exhibited catch-up growth over this period. Factors positively associated with catch-up growth included maternal height (odds ratio (OR) = 1.08 [1.05-1.11]), household wealth (OR = 3.61 [1.90-6.84]), maternal (OR = 2.43 [1.30-4.56]) or paternal (OR = 1.46 [1.05-2.03]) education, and households with two or more adult females (OR = 1.91 [1.26-2.88]). Factors negatively associated with catch-up growth were two (OR = 0.64 [0.45-0.89]) or three or more (OR = 0.44 [0.29-0.66]) preschool children in the household and the infant being currently breastfed (OR = 0.59 [0.41-0.88]). Catch-up growth was exhibited among approximately a quarter of infants despite living in challenging environments associated with extremely high rates of early infant stunting. Several modifiable factors were identified that might represent suitable programme intervention points to off-set early infant stunting in rural Pakistan.

SUBMITTER: Pradeilles R

PROVIDER: S-EPMC6587826 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Diarrhea and linear growth faltering continue to burden low-income countries and are among the most important contributors to poor health during early childhood. Diarrhea is thought to adversely affect linear growth, but catch-up growth can occur if no additional insults are experienced. We sought to characterize catch-up growth in relation to diarrhea burden in a multisite dataset of 1007 children. Using longitudinal anthropometry and diarrheal surveillance data from 7 cohort studies in 4 countries, we examined the relation between diarrhea prevalence and growth in 3- to 6-mo periods using linear mixed-effect models. Growth during each period was calculated as a function of age using linear splines. We incorporated the longitudinal prevalence of diarrhea in both current and previous periods into the model. Diarrhea during the current period was associated with slower linear and ponderal growth. Faster (catch-up) growth in length was observed in children with no diarrhea in age groups immediately after an age group in which diarrhea was experienced [age group >6-12 mo: 0.03 mm/mo for each percentage diarrhea prevalence in the previous period (95% CI: 0.007, 0.06) relative to 11.3 mm/mo mean growth rate; age group >12-18 mo: 0.04 mm/mo (95% CI: 0.02, 0.06) relative to 8.9 mm/mo mean growth rate; age group >18-24 mo: 0.04 mm/mo (95% CI: 0.003, 0.09) relative to 7.9 mm/mo mean growth rate]. The associations were stronger in boys than in girls when separate models were run. Similar results were observed when weight was the outcome variable. When diarrheal episodes are followed by diarrhea-free periods in the first 2 y of life, catch-up growth is observed that may allow children to regain their original trajectories. The finding of a greater effect of diarrhea on linear growth in boys than in girls was unexpected and requires additional study. Diarrhea burdens are high throughout the first 2 y of life in these study sites, therefore reducing the likelihood of catch-up growth. Extending diarrhea-free periods may increase the likelihood of catch-up growth and decrease the prevalence of stunting.

Project description:Nutrition in pregnancy and early childhood affects later blood pressure and precursors of atherosclerosis, but its influence on arterial stiffness is unexplored. This study determines whether exposure to improved nutrition during early life influences Augmentation index (AI) and pulse wave velocity (PWV) in mid-adulthood. We included 1221 adults (37-54y) who participated in a cluster-randomized nutritional supplementation trial of a protein-energy beverage (Atole), conducted between 1969-1977 in Guatemala. The comparison group received Fresco, a low-calorie protein-free beverage. In 2015-17, we measured anthropometry (weight, height, and waist-to-height ratio); AI and PWV (using carotid-femoral tonometry); blood pressure; fasting plasma glucose and serum lipids; and sociodemographic characteristics. Based on patterns of exposure, we characterized participants as fully, partially or unexposed to the intervention from conception to their second birthday (the 'first 1000 days'). We fit pooled and sex-specific models using intention-to-treat, difference-in-difference regression analysis to test whether exposure to the supplement in the first 1000 days was associated with AI and PWV in adulthood adjusting for basal and current sociodemographic variables and current life-style and cardio-metabolic risk factors. Prevalence of obesity in men and women was 39.6% and 19.6%, and prevalence of hypertension was 44.0% and 36.0%, respectively. Women had higher AI (34.4±9.6%) compared to men (23.0± 9.8%), but had similar PWV (7.60±1.13 m/s and 7.60±1.31, respectively). AI did not differ significantly across intervention groups. PWV was lower in individuals with full exposure to the supplement during the first 1000 days (-0.39m/s, 95% CI -0.87, 0.09; p = 0.1) compared to unexposed individuals. This difference was similar after adjusting for cardio-metabolic risk factors (-0.45m/s; 95%C-0.93, 0.01; p = 0.06). Exposure to improved nutrition during the first 1000 days was marginally associated with lower PWV, but not with AI.

Project description:In developed countries, children with intrauterine growth restriction (IUGR) or born preterm (PT) tend to achieve catch-up growth. There is little information about height catch-up in developing countries and about height catch-down in both developed and developing countries. We studied the effect of IUGR and PT birth on height catch-up and catch-down growth of children from two cohorts of liveborn singletons. Data from 1,463 children was collected at birth and at school age in Ribeirão Preto (RP), a more developed city, and in São Luís (SL), a less developed city. A change in z-score between schoolchild height z-score and birth length z-score ≥ 0.67 was considered catch-up; a change in z-score ≤ -0.67 indicated catch-down growth. The explanatory variables were: appropriate weight for gestational age/PT birth in four categories: term children without IUGR (normal), IUGR only (term with IUGR), PT only (preterm without IUGR) and preterm with IUGR; infant's sex; maternal parity, age, schooling and marital status; occupation of family head; family income and neonatal ponderal index (PI). The risk ratio for catch-up and catch-down was estimated by multinomial logistic regression for each city. In RP, preterms without IUGR (RR = 4.13) and thin children (PI<10(th) percentile, RR = 14.39) had a higher risk of catch-down; catch-up was higher among terms with IUGR (RR = 5.53), preterms with IUGR (RR = 5.36) and children born to primiparous mothers (RR = 1.83). In SL, catch-down was higher among preterms without IUGR (RR = 5.19), girls (RR = 1.52) and children from low-income families (RR = 2.74); the lowest risk of catch-down (RR = 0.27) and the highest risk of catch-up (RR = 3.77) were observed among terms with IUGR. In both cities, terms with IUGR presented height catch-up growth whereas preterms with IUGR only had height catch-up growth in the more affluent setting. Preterms without IUGR presented height catch-down growth, suggesting that a better socioeconomic situation facilitates height catch-up and prevents height catch-down growth.

Project description:A large body of cross-sectional evidence finds strong and consistent associations between social support and intimate partner violence (IPV). However, the directionality of this relationship has not been firmly established due to a dearth of longitudinal evidence. Using cohort study data collected over a 3 year period from 945 women in rural Pakistan, we investigated the longitudinal relationship between IPV and social support. Friend and family social support was measured with the Multidimensional Perceived Social Support Scale, and IPV was measured with questions adopted from the World Health Organization's Violence Against Women Instrument, which was used to construct a measure of IPV severity. We estimated longitudinal associations in linear regression models that controlled for women's educational level, age at marriage, age, household composition, household assets, depressive symptoms, and Adverse Childhood Experiences. We found evidence of a bi-directional, mutually re-enforcing relationship that showed unique associations by type of social support. Specifically, we found that high social support from family, though not friends, decreased IPV severity 1 year later, and that higher IPV severity led to reductions in both friend and family social support 1 year later. Results suggest that interventions involving family members could be especially effective at reducing IPV in this context, and – given that low social support leads to many adverse health outcomes – results suggest that IPV can result in secondary harms due to diminished social support. In summary, our study confirms a bi-directional relationship between IPV and social support and suggests that IPV interventions that integrate social support may be especially effective at reducing IPV and mitigating secondary harms. Highlights • Directionality between social support and intimate partner violence (IPV) unclear.• Investigated bi-directional relationship between IPV and social support.• Used longitudinal cohort study data from rural Pakistan.• High social support from family, though not friends, decreased IPV severity.• Higher IPV severity led to reductions in both friend and family social support.

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Factors associated with catch-up growth in early infancy in rural Pakistan: A longitudinal analysis of the women's work and nutrition study.

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