Background: Growth failure is associated with adverse consequences, but studies need to control adequately for confounding.Objective: We related height-for-age z scores (HAZs) and stunting at age 24 mo to adult human capital, marriage, fertility, health, and economic outcomes.Design: In 2002–2004, we collected data from 1338 Guatemalan adults (aged 25–42 y) who were studied as children in 1969–1977. We used instrumental variable regression to correct for estimation bias and adjusted for potentially confounding factors.Results: A 1-SD increase in HAZ was associated with more schooling (0.78 grades) and higher test scores for reading and nonverbal cognitive skills (0.28 and 0.25 SDs, respectively), characteristics of marriage partners (1.39 y older, 1.02 grade more schooling, and 1.01 cm taller) and, for women, a higher age at first birth (0.77 y) and fewer number of pregnancies and children (0.63 and 0.43, respectively). A 1-SD increase in HAZ was associated with increased household per capita expenditure (21%) and a lower probability of living in poverty (10 percentage points). Conversely, being stunted at 2 y was associated with less schooling, a lower test performance, a lower household per capita expenditure, and an increased probability of living in poverty. For women, stunting was associated with a lower age at first birth and higher number of pregnancies and children. There was little relation between either HAZ or stunting and adult health.Conclusion: Growth failure in early life has profound adverse consequences over the life course on human, social, and economic capital.
This article reviews key findings about the long-term impact of a nutrition intervention carried out by the Institute of Nutrition of Central America and Panama from 1969 to 1977. Results from follow-up studies in 1988-89 and 2002-04 show substantial impact on adult human capital and economic productivity. The 1988-89 study showed that adult body size and work capacity increased for those provided improved nutrition through age 3 y, whereas the 2002-04 follow-up showed that schooling was increased for women and reading comprehension and intelligence increased in both men and women. Participants were 26-42 y of age at the time of the 2002-04 follow-up, facilitating the assessment of economic productivity. Wages of men increased by 46% in those provided with improved nutrition through age 2 y. Findings for cardiovascular disease risk factors were heterogeneous; however, they suggest that improved nutrition in early life is unlikely to increase cardiovascular disease risk later in life and may indeed lower risk. In conclusion, the substantial improvement in adult human capital and economic productivity resulting from the nutrition intervention provides a powerful argument for promoting improvements in nutrition in pregnant women and young children.
To study the role of nutrition in the association of birth size and childhood growth with development of cardiovascular disease, the authors in 2002-2004 surveyed 665 men and 790 women aged 25-42 years who had been exposed as children to a community-randomized nutrition supplementation intervention in four villages in eastern Guatemala. Exposure was associated with a lower fasting glucose level (7.0 mg/dl, 95% confidence interval (CI): 0.5, 13.5) for exposure at ages 36-72 months; lower systolic blood pressure (3.0 mmHg, 95% CI: 0.4, 5.6) for exposure at ages 24-60 months; and a lower triglyceride level (sex-adjusted; 22.2 mg/dl, 95% CI: 0.4, 44.1) and higher high density lipoprotein cholesterol level (males only; 4.7 mg/dl, 95% CI: 1.5, 7.9) for exposure prior to age 36 months. Improved nutrition at any age prior to 7 years was not associated with diastolic blood pressure, total or low density lipoprotein cholesterol level, or prevalence of the metabolic syndrome. Interventions designed to address nutrient deficiencies and ameliorate stunting that are targeted at pregnant women and young children are unlikely to increase cardiovascular disease risk later in life and may instead lower the risk.
This article uses census data and village histories to examine changes over the last 35 years in the four villages where the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969-77) was conducted and offers a rare picture of development and change in rural localities over a long period of time. In addition, by characterizing the environment in which the subjects of this study were raised, we provide context for and inputs into quantitative analyses of data collected at various points in time on these subjects. The villages have undergone massive demographic, social, and economic change. Initial differences have conditioned many of these changes, especially differences associated with agricultural potential and location. Originally these villages were rather isolated, but road and transportation access has improved substantially. The populations in the villages have more than doubled and also have aged. While marriage patterns have held steady, religious practice has changed a great deal. After many years of steady out-migration, three of the four villages are more recently experiencing net in-migration, a pattern associated with ease of access. Schooling access and outcomes also have improved, with average grades of schooling nearly tripling and literacy doubling to levels currently above national averages. Although agriculture remains an important component of individual livelihood strategies, non-agricultural sources of employment have become more important. Much of this change is associated with declining agricultural markets and increased access to non-agricultural jobs near the villages and in the capital. Accompanying these changes has been an improvement in living standards as measured by a number of indicators of household living conditions and consumer durable goods.
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