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Long run height and education implications of early life growth faltering: a synthetic panel analysis of 425 birth cohorts in 21 low- and middle-income countries.

ABSTRACT: BACKGROUND:We estimated the associations between exposure to early life growth faltering at the population level and adult height and education outcomes in a sample of 21 low- and middle-income countries. METHODS:We conducted a synthetic panel analysis of 425 birth cohorts across 126 regions in 21 LMICs surveyed in the Demographic and Health Surveys (DHS) both as children and as adults. Data from historic (1987-1993) DHS survey rounds were used to compute average height-for-age z-scores at the province-birth-year level. Cohort measures of early life growth were then linked to adult height and educational attainment measures collected on individuals from the same cohorts in the 2006-2014 DHS survey rounds. The primary exposure of interest was population-level early life growth (region-birth year average HAZ) and growth faltering (region-birth year stunting prevalence). Multivariable linear regression models were used to estimate the associations between adult outcomes and population-level measures of early life linear growth. RESULTS:The average cohort height-for-age z-score (HAZ) in childhood was -?1.53 [range: -?2.73, -?0.348]. In fully adjusted models, each unit increase in cohort childhood HAZ was associated with a 2.0?cm [95% CI: 1.09-2.9] increase in adult height, with larger associations for men than for women. Evidence for the association between early childhood height and adult educational attainment was found to be inconclusive (0.269, 95% CI: [-?0.68-1.22]). CONCLUSIONS:While early childhood linear growth at the cohort level appears to be highly predictive of adult height, the empirical association between early life growth and adult educational attainment seems weak and heterogeneous across countries. REGISTRATION:This study was registered on May 10, 2017 at the ISRCTN Registry ( http://www.isrctn.com ), registration number ISRCTN82438662 .

SUBMITTER: Karra M

PROVIDER: S-EPMC6611035 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Long run height and education implications of early life growth faltering: a synthetic panel analysis of 425 birth cohorts in 21 low- and middle-income countries.

Karra Mahesh M Fink Günther G

BMC public health 20190704 1

<h4>Background</h4>We estimated the associations between exposure to early life growth faltering at the population level and adult height and education outcomes in a sample of 21 low- and middle-income countries.<h4>Methods</h4>We conducted a synthetic panel analysis of 425 birth cohorts across 126 regions in 21 LMICs surveyed in the Demographic and Health Surveys (DHS) both as children and as adults. Data from historic (1987-1993) DHS survey rounds were used to compute average height-for-age z- ...[more]

PMID: 31272440

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Project description:Stunting prevalence is an indicator of a country's progress towards United Nations' Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%-62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress.

Dataset Information

Long run height and education implications of early life growth faltering: a synthetic panel analysis of 425 birth cohorts in 21 low- and middle-income countries.

Publications

Long run height and education implications of early life growth faltering: a synthetic panel analysis of 425 birth cohorts in 21 low- and middle-income countries.

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