Infant and Child Growth and Fatness and Fat Distribution in Guatemalan Adults

Abstract

To examine whether poor growth in utero or young childhood is associated with adult abdominal fatness in a developing country context, the authors analyzed prospectively collected data on 372 female and 161 male Guatemalans measured as children between 1969 and 1977 and remeasured as adults in 1988-1989 (men and women) and 1991-1994 (women only). Childhood stunting (height-for-age z score) was associated with a lower body mass index and percent body fat in men, while no associations were found in women. In both sexes, however, severely stunted children had significantly greater adult abdominal fatness (waist:hip ratio), once overall fatness and confounders were controlled. The adult waist:hip ratio (x100) was increased by 0.65 (95% confidence interval 0.10 to 1.20) in men and 0.29 (95% confidence interval -0.03 to 0.61) in women for each height-for-age z score less at age three. Migration to urban centers was significantly associated with an even greater waist:hip ratio in severely stunted females (p = 0.03). In a subsample of 137 women, short and thin newborns had significantly greater adult abdominal fatness compared with long and thin or short and fat newborns or children who became stunted postnatally. The adult waist:hip ratio (x100) was increased by 1.58 (95% confidence interval 0.35 to 2.81) for each kilogram less birth weight. The authors conclude that, in countries where maternal and child malnutrition exists alongside rapid economic development and urban migration, abdominal obesity and related chronic diseases are likely to increase.

The association between early childhood stunting and weight status in late adolescence

“…Overweight was more common among non-stunted female subjects than in the stunted group, with one-third of the non-stunted female subjects already being overweight. In Guatemala, no association between stunting and adult BMI or body fat was found in women, 12 and in the present study, although mean BMI and skinfold thicknesses tended to be higher in the nonstunted group compared with stunted females, the difference was not statistically significant. These results suggest that there has been some catch-up in adiposity among the stunted girls, as in early childhood the stunted children were thinner.…”

“…Evidence for associations between stunting and centralization of obesity is mixed. 12,13 In our earlier follow-up of this cohort at age 11 years, stunted children had higher SSF/TSF ratios than non-stunted children, but this difference was largely due to birth weight, which predicted central obesity and differed between the groups. 10 The stunted subjects remained significantly shorter than the non-stunted group.…”

“…There are few studies in which stunted children's long-term growth has been followed and only one of which we are aware in which follow-up has continued into young adulthood. 12,13 In that study, stunting was associated with lower BMI and body fat in men at age 18-24 years. 12 Similarly in our study, among male subjects, mean BMI and skinfold thicknesses were lower in the stunted group than in the non-stunted group.…”

“…12,13 In that study, stunting was associated with lower BMI and body fat in men at age 18-24 years. 12 Similarly in our study, among male subjects, mean BMI and skinfold thicknesses were lower in the stunted group than in the non-stunted group. In Jamaica, the prevalence of overweight is much higher among women than in men 23 and this gender difference was already evident in our cohort.…”

“…Follow-up of Guatemalan children showed that childhood stunting was associated with lower BMI and body fat among men at age 18-24 years but no relation was found in women. 12 The study also suggested that stunting was associated with greater central adiposity after adjustment for current BMI. However, in a more recent follow-up at age 21-27 years, no relationship with central adiposity was found, but as before shorter height at age 2 years was associated with lower body fat in adults.…”