SummaryBackgroundFast weight gain and linear growth in children in low-income and middle-income countries are associated with enhanced survival and improved cognitive development, but might increase risk of obesity and related adult cardiometabolic diseases. We investigated how linear growth and relative weight gain during infancy and childhood are related to health and human capital outcomes in young adults.MethodsWe used data from five prospective birth cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa. We investigated body-mass index, systolic and diastolic blood pressure, plasma glucose concentration, height, years of attained schooling, and related categorical indicators of adverse outcomes in young adults. With linear and logistic regression models, we assessed how these outcomes relate to birthweight and to statistically independent measures representing linear growth and weight gain independent of linear growth (relative weight gain) in three age periods: 0–2 years, 2 years to mid-childhood, and mid-childhood to adulthood.FindingsWe obtained data for 8362 participants who had at least one adult outcome of interest. A higher birthweight was consistently associated with an adult body-mass index of greater than 25 kg/m2 (odds ratio 1·28, 95% CI 1·21–1·35) and a reduced likelihood of short adult stature (0·49, 0·44–0·54) and of not completing secondary school (0·82, 0·78–0·87). Faster linear growth was strongly associated with a reduced risk of short adult stature (age 2 years: 0·23, 0·20–0·52; mid-childhood: 0·39, 0·36–0·43) and of not completing secondary school (age 2 years: 0·74, 0·67–0·78; mid-childhood: 0·87, 0·83–0·92), but did raise the likelihood of overweight (age 2 years: 1·24, 1·17–1·31; mid-childhood: 1·12, 1·06–1·18) and elevated blood pressure (age 2 years: 1·12, 1·06–1·19; mid-childhood: 1·07, 1·01–1·13). Faster relative weight gain was associated with an increased risk of adult overweight (age 2 years: 1·51, 1·43–1·60; mid-childhood: 1·76, 1·69–1·91) and elevated blood pressure (age 2 years: 1·07, 1·01–1·13; mid-childhood: 1·22, 1·15–1·30). Linear growth and relative weight gain were not associated with dysglycaemia, but a higher birthweight was associated with decreased risk of the disorder (0·89, 0·81–0·98).InterpretationInterventions in countries of low and middle income to increase birthweight and linear growth during the first 2 years of life are likely to result in substantial gains in height and schooling and give some protection from adult chronic disease risk factors, with few adverse trade-offs.FundingWellcome Trust and Bill & Melinda Gates Foundation.
Background Both young and advanced maternal age is associated with adverse birth and child outcomes. Few studies have examined these associations in low- and middle-income countries (LMICs) and none have studied adult outcomes in the offspring. Methods Pooled data from five birth cohorts (total N=19,403) in Brazil, Guatemala, India, the Philippines and South Africa were used to examine associations of maternal age with offspring birth weight, gestational age, height-for-age and weight-for-height Z-scores in childhood, attained schooling, and adult height, body composition (BMI, waist circumference, fat and lean mass) and cardiometabolic risk factors (blood pressure and fasting plasma glucose concentration), along with binary variables derived from these. Analyses were unadjusted and adjusted for maternal socio-economic status, height and parity, and breastfeeding duration. Findings In unadjusted analyses, younger (≤19 years) and older (≥35 years) maternal age was associated with lower birth weight, gestational age, child nutritional status and schooling. Associations with younger maternal age remained after adjustment; odds ratios (OR) for low birth weight, pre-term birth, 2-year stunting and failure to complete secondary schooling were 1·18 (95% CI: 1·02,1·36), 1·26 (1·03,1·53), 1·46 (1·25,1·70) and 1·38 (1·18,1·62) respectively compared with mothers aged 20-24 years. After adjustment, older maternal age remained associated with increased risk of pre-term birth (OR=1·33 (1·05,1·67)) but children of older mothers had less 2-year stunting (OR=0·64 (0·54,0·77)) and failure to complete secondary schooling (OR=0·59 (0·48,0·71)). Offspring of both younger and older mothers had higher adult fasting glucose concentrations (~0·05 mmol/l). Interpretation Children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling. Efforts to prevent early childbearing should be strengthened. After adjusting for confounders, children of older mothers have advantages in nutritional status and schooling. Extremes of maternal age may be associated with disturbed offspring glucose metabolism. Funding Wellcome Trust, Bill and Melinda Gates Foundation
Growth failure is cumulative, and short stature is associated with multiple indices of reduced human capital. Few studies have been able to address in a single analysis both consideration of the timing of growth failure and comparison across populations. We analyzed data from birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa (n = 4,659). We used data on length at birth (available for three of the five cohorts), 12 mo, 24 mo, and mid-childhood to construct cohort- and sex- specific conditional length measures. We modeled adult height as a function of conditional length in childhood. The five cohorts experienced varying degrees of growth failure. As adults, the Brazil sample was 0.35 ± 0.89 standard deviations (SD) below the World Health Organization reference, while adult Guatemalans were 1.91 ± 0.87 SD below the reference. All five cohorts experienced a nadir in height for age Z-score at 24 mo. Birth length (in the three cohorts with this variable), and conditional length at 12 mo (in all five cohorts) were the most strongly associated with adult height. Growth in the periods 12–24 mo and 24 mo to mid-childhood showed inconsistent patterns across tertiles of adult height. Despite variation in the magnitude of cumulative growth failure across cohorts, the five cohorts show highly consistent age-specific associations with adult stature. Growth failure prior to age 12 mo was most strongly associated with adult stature. These consistencies speak to the importance of interventions to address intrauterine growth failure and growth failure in the first 12 mo of life. Am. J. Hum. Biol. 2010. © 2009 Wiley-Liss, Inc.
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