Abstract
BackgroundEarly childhood is a critical stage of physical and cognitive growth that forms the foundation of future wellbeing. Stunted growth is presented in one of every 4 children worldwide and contributes to developmental impairment and under-five mortality. Better understanding of early growth patterns should allow for early detection and intervention in malnutrition. We aimed to characterize early child growth patterns and quantify the change of growth curves from the World Health Organization (WHO) Child Growth Standards.MethodsIn a cohort of 626 Bangladesh children, longitudinal height-for-age z-scores (HAZ) were modelled over the first 24 months of life using functional principal component analysis (FPCA). Deviation of individual growth from the WHO standards was quantified based on the leading functional principal components (FPCs), and growth faltering was detected as it occurred. The risk factors associated with growth faltering were identified in a linear regression.ResultsNinety-eight percent of temporal variation in growth trajectories over the first 24 months of life was captured by two leading FPCs (FPC1 for overall growth and FPC2 for change in growth trajectory). A derived index, adj-FPC2, quantified the change in growth trajectory (i.e., growth faltering) relative to the WHO standards. In addition to HAZ at birth, significant risk factors associated with growth faltering in boys included duration of breastfeeding, family size and income and in girls maternal weight and water source.ConclusionsThe underlying growth patterns of HAZ in the first 2 years of life were delineated with FPCA, and the deviations from the WHO standards were quantified from the two leading FPCs. The adj-FPC2 score provided a meaningful measure of growth faltering in the first 2 years of life, which enabled us to identify the risk factors associated with poor growth that would have otherwise been missed. Understanding faltering patterns and associated risk factors are important in the development of effective intervention strategies to improve childhood growth globally.Trial registrationClinicalTrials.gov Identifier: NCT02734264, registered 22 March, 2016.
Highlights
Childhood is a critical stage of physical and cognitive growth that forms the foundation of future wellbeing
Risk factor analysis After the adj-FPC2 score was calculated to quantify growth faltering, we considered it as the response and evaluated its associated risk factors in a linear regression model
The variation in growth trajectories of height-for-age z-scores (HAZ) for both boys and girls were characterized by two leading Functional principal component (FPC), where FPC1 captured the overall growth pattern and FPC2 captured the change in growth trajectory from birth to age 2 years
Summary
Childhood is a critical stage of physical and cognitive growth that forms the foundation of future wellbeing. The World Health Organization (WHO) growth standards for infants and young children can be used to identify children who are at risk of growth faltering, including stunting and wasting [1, 2] (http://www.who.int/childgrowth/ mgrs/en/), (http://www.who.int/nutgrowthdb/about/ introduction/en/index2.html). Malnutrition and stunting are prevalent in developing countries and cause substantial childhood morbidity and mortality [2]. Morbidity from malnutrition before age 5 years affects physical growth and cognitive development in 200 million children, including 86 million children in India subcontinent [2, 4]. It is important to characterize growth patterns in early childhood and identify the determinants associated with growth faltering to facilitate screening strategies and development of effective interventions [2, 9, 10]
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