Stunting in infancy, pubertal trajectories and adult body composition: the Birth to Twenty Plus cohort, South Africa

Glory Chidumwa,Juliana Kagura,Feziwe Mpondo,Lisa J Ware,Tinashe Chikowore,Lisa K Micklesfield,Alessandra Prioreschi,Shane A Norris,Lukhanyo H Nyati,Rihlat Said-Mohamed

doi:10.1038/s41430-020-00716-1

Abstract

Background/objectivesChildhood rapid growth and earlier puberty onset have been associated with adult obesity. However, the association between childhood stunting, pubertal timing and adult obesity is unclear. We examined whether the relationship between stunting at age 2 years (y) and body composition at 23 years is mediated by adolescent body mass index, and pubertal development, using the Birth-to-Twenty Plus cohort (South Africa).Subjects/methodsFor 1036 participants, data on anthropometrics between birth and 23 years, maternal factors, and pubertal development (Tanner scale at 9–16 years) were collected. Stunting at 2 years (height-for-age z-score < −2), 5–18 years BMI-for-age trajectories, pubertal development trajectories, and DXA-derived fat mass (FM) and fat free mass (FFM) at 23 years were determined. Data were analysed using hierarchical regressions and structural equation models.ResultsStunting was directly associated with slower pubertal development and with shorter adult stature, but was not associated with adolescent BMI trajectories, adult FM or FFM. However, stunting was indirectly associated with adult FM and FFM through the direct associations between slower pubertal development and lower FM and between shorter height and lower FFM. BMI trajectories were independently associated with FM and FFM.ConclusionsBeing stunted in this population predicted adult body composition through slower pubertal development and shorter adult stature.

Highlights

In low- and middle-income countries (LMICs), obesity has become a critical determinant of morbidity and mortality due to its association with higher risks of cardiovascular and metabolic diseases [1]
In LMICs, both rapid linear growth and weight gain between birth and 2 years of age have been shown to contribute to greater adult lean mass and height in comparison to adult fat mass (FM), while from 2 years of age onwards evidence is consistent with observations in high income countries, which shows that rapid weight gain becomes a risk factor for overweight/obesity, and greater FM [6,7,8,9,10,11]
Using hierarchical regressions and structural equation modelling (SEM), this study aimed to determine whether changes in body mass index (BMI) from childhood through to late adolescence, and/or the tempo of pubertal development, mediate the association between stunting, and height and body composition (FM and fat free mass (FFM)) in young adulthood in the BT20+ cohort

Summary

Introduction

In low- and middle-income countries (LMICs), obesity has become a critical determinant of morbidity and mortality due to its association with higher risks of cardiovascular and metabolic diseases [1]. Pubertal timing (onset) and progression (tempo, speed of pubertal development) may play an important role in influencing body composition and obesity risk in adulthood [12, 13]. Findings from LMICs have consistently shown that greater height and weight gain during early childhood predict an earlier onset of puberty and a faster tempo of pubertal development [14, 15]. Both greater growth rate during childhood and faster pubertal development during adolescence were found to be risk factors for overweight and obesity in young adulthood [6, 10]. Stunting in children has not been consistently associated with the risk of overweight or obesity in childhood and adolescence [18,19,20,21,22]

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