Newborn length predicts early infant linear growth retardation and disproportionately high weight gain in a low-income population

Abstract

Background Stunting is prevalent by the age of 6 mo in the indigenous population of the Western Highlands of Guatemala. Aim The objective of this study was to determine the time course and predictors of linear growth failure and weight-for-age in early infancy. Study Design and Subjects One hundred and forty eight term newborns had measurements of length and weight in their homes, repeated at 3 and 6 mo. Maternal measurements were also obtained. Results Mean ± SD length-for-age Z-score (LAZ) declined from newborn -1.0 (1.01) to -2.20 (1.05) and -2.26 (1.01) at 3 and 6 mo respectively. Stunting rates for newborn, 3 and 6 mo were 47%, 53% and 56% respectively. A multiple regression model (R2 = 0.64) demonstrated that the major predictor of LAZ at 3 mo was newborn LAZ with the other predictors being newborn weight-for-age Z-score (WAZ), gender and maternal education*maternal age interaction. Because WAZ remained essentially constant and LAZ declined during the same period, weight-for-length Z-score (WLZ) increased from -0.44 to +1.28 from birth to 3 mo. The more severe the linear growth failure, the greater WAZ was in proportion to the LAZ. Conclusion The primary conclusion is that impaired fetal linear growth is the major predictor of early infant linear growth failure indicating that prevention needs to start with maternal interventions.

Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala

“…In our view, any exclusion of infants based on gestational age actually reduces the accounting of net low length at birth. We must admit, however, that the disparate criteria for inclusion or exclusion by gestational age make comparisons across our two Guatemalan sites, and with the publication from the centre of the nation (19) , less precise. This heterogeneity, moreover, may have been a factor in the time-dependent association illustrated in Fig.…”

“…Finally, therefore, while perhaps not providing the definitive incidences of stunting in the recently born infant for either the urban-clinic or the rural-village sector of Quetzaltenango Province, a substantial and disconcerting number of individuals have full linear growth retardation of intra-uterine origin. Accepting, then, that rates of stunting -and a general leftward shift of HAZ distributions -are present in certain neonates in the interior of Guatemala here and elsewhere (19) adds a new dimension to established policy considerations. The demonstrable existence of stunting-atbirth might serve to redirect and reorient the strategies and policies surrounding the first 1000 d policy.…”

Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of Age

“…Guatemala has the highest rate of child stunting in the Americas [16], estimated at 47%, 53%, and 56% at birth, three, and six months of age, respectively [3]. In addition to high rates of stunting and undernutrition, Guatemala is facing an increasing prevalence of obesity/overweight and metabolic syndrome, leading to a double burden of malnutrition [17–19].…”

“…More than half of the 11 million deaths of children under five are attributable to malnutrition, which may cause increased susceptibility to infectious disease [1,2]. Malnourished children experience increases in chronic illnesses and disabilities, have impaired brain function, and suffer from loss of physical and economic productivity [1,3]. …”

“…Other predictors of child malnutrition identified in previous literature include parental education levels, with maternal education more strongly predictive than paternal education, social deprivation, number of children in household, and sources of drinking water [1]. Previous literature in the Western highlands of Guatemala found that significant predictors of low HAZ at 3 months were low newborn HAZ, male sex, and the interaction between maternal education and maternal age [3]. …”