Temporal Patterns in Linear and Ponderal Growth Velocity Among Children 6–23 Months in Burkina Faso

Abstract

Abstract Objectives Although studies have found co-occurrence of stunting (low height-for-age) with wasting (low weight-for-height), and found that wasting often precedes stunting, none has investigated links between velocities of linear and ponderal growth over time. Understanding temporal dependencies and growth trajectories in both height and weight can help determine optimal timing of interventions to prevent wasting and stunting. Methods We re-analyzed monthly height and weight data from a cohort of 6112 children aged 6–23 months in a supplementary feeding trial in Burkina Faso, conducted from July 2014 to September 2016. We built mixed effects models with multiple lag periods to determine links between linear growth trajectory (cm gained/month) and ponderal growth trajectory (kg gained/month), and vice versa, controlling for age, season, study arm, and morbidities. Lag periods included growth velocity measurements taken one (t-1) to four (t-4) months prior to the outcome velocity. Results On average in these data, ponderal growth is positively associated with future linear growth, but linear growth is followed by lower future weight gain. Doubling the average ponderal growth velocity (0.18 kg/month) is associated with 3%–0.2% higher linear growth velocity one to four months later, while doubling the average linear growth velocity (0.95 cm/month) is associated with 16%–3% lower ponderal growth velocity one to four months later. In all cases, the magnitude of a growth velocity's association with future growth velocities decreases as the time interval increases. These results are all significant at the 5% level. Conclusions We find that episodes of faster linear growth are associated with lower subsequent ponderal growth. This finding demonstrates temporal dependencies and suggests that, for infants in Burkina Faso, linear growth spurts may not be accompanied by sufficient increases in dietary intake to avoid a slowdown in weight gain. To improve child growth, programs should combine strategies that address both height and weight. Funding Sources United States Agency for International Development, Office of Food for Peace.