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Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
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2013 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 42, no 5, 1340-1355 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Low- and middle-income countries continue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30-40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain.

METHODS:

Using extant longitudinal birth cohorts (n = 19) with data on birthweight, gestational age and child anthropometry (12-60 months), we estimated study-specific and pooled risk estimates of stunting, wasting and underweight by small-for-gestational age (SGA) and preterm birth.

RESULTS:

We grouped children according to four combinations of SGA and gestational age: adequate size-for-gestational age (AGA) and preterm; SGA and term; SGA and preterm; and AGA and term (the reference group). Relative to AGA and term, the OR (95% confidence interval) for stunting associated with AGA and preterm, SGA and term, and SGA and preterm was 1.93 (1.71, 2.18), 2.43 (2.22, 2.66) and 4.51 (3.42, 5.93), respectively. A similar magnitude of risk was also observed for wasting and underweight. Low birthweight was associated with 2.5-3.5-fold higher odds of wasting, stunting and underweight. The population attributable risk for overall SGA for outcomes of childhood stunting and wasting was 20% and 30%, respectively.

CONCLUSIONS:

This analysis estimates that childhood undernutrition may have its origins in the foetal period, suggesting a need to intervene early, ideally during pregnancy, with interventions known to reduce FGR and preterm birth.

Place, publisher, year, edition, pages
2013. Vol. 42, no 5, 1340-1355 p.
Keyword [en]
Foetal growth restriction, preterm birth, stunting, wasting, childhood
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-208314DOI: 10.1093/ije/dyt109ISI: 000326726000023PubMedID: 23920141OAI: oai:DiVA.org:uu-208314DiVA: diva2:651900
Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2017-12-06Bibliographically approved

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Persson, Lars-Åke

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