Stunting in infancy, pubertal trajectories and adult body composition: the Birth to Twenty Plus cohort, South Africa (original) (raw)
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The Journal of nutrition, 2018
The role that childhood stunting plays in the development of overweight and obesity later in life is not well understood, particularly in adolescence and young adulthood, because most studies have only followed up through midchildhood. The objective of this study was to examine the relation between stunting and age-specific patterns of overweight and obesity incidence from early childhood to young adulthood in the context of a country in the process of the nutrition transition while these children were growing up. We analyzed data from 895 participants in the Birth-to-Twenty Plus Cohort (Bt20+), an urban South African birth cohort initiated in 1990. Anthropometric data were collected at multiple ages and participants were included if they provided height at age 24 mo and ≥1 measure of body mass index [BMI; weight (kg)/height (m)2] in each of the following time periods: 4-8 y, 11-12 y, 13-15 y, 16-18 y, and 22-24 y. We defined stunting at age 24 mo as height-for-age z score <2 and...
Stunting and obesity in childhood: a reassessment using longitudinal data from South Africa
International Journal of Epidemiology, 2012
"Background A series of cross-sectional studies have found a relationship between stunting and obesity in childhood. Because height appears in both the numerator of indices of stunting and the denominator of indices of obesity, random errors made by fieldworkers measuring heights can produce negative bias in estimates of this relationship. Methods With longitudinal data, height can be instrumented with its lagged value in a two-stage probit regression model, purging the estimated association between the probability of being obese or underweight and the height-for-age z-score of this errors-in-variables bias. Such a model is fitted to a cohort of 1110 primary-school-age children measured in 1993–2004 in a panel study in KwaZulu-Natal, South Africa. The study also collected detailed data on households’ demographic and socio-economic characteristics. Results Risk factors for stunting, wasting and obesity differed in this population. Stunting was not associated with childhood obesity in either the cross-sectional or two-stage models. In the cross-sectional analysis, however, random measurement errors masked a negative association between children’s height-for-age and their probability of being underweight or wasted that emerged in the two-stage instrumental variable models. This association was further amplified, rather than attenuated, by controlling for children’s household income, racial group, residence and mother’s education. Conclusions The validity of the findings of earlier cross-sectional studies of the association between stunting and obesity in childhood is dependent on the precision with which they measured height. Random measurement error can also mask an association between being stunted and underweight in cross-sectional studies.
The Journal of nutrition, 2016
Height and adiposity track over childhood, but few studies, to our knowledge, have longitudinally examined the mediating relation of the timing and progression of puberty. We assessed interrelations between prepubertal height and body mass index, the progression through puberty, and young adult height and adiposity. We analyzed data from the Birth to Twenty Plus study (females, n = 823; males, n = 765). Serial measures of anthropometry and pubertal development were obtained between ages 9 and 16 y. We used latent class growth analysis to categorize pubertal development with respect to pubic hair (females and males), breasts (females), and genitalia (males) development. Adult height and weight were obtained at ages 18 to 20 y. Among females, higher latent class (earlier initiation and faster progression through puberty) was associated with an increased risk of obesity [pubic hair class 3 compared with class 1: RR, 3.41 (95% CI: 1.57, 7.44)] and inconsistent associations with height. ...
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2004
To investigate the relationship between stunting and overweight among 10-15-y-old children of the North West Province in South Africa. A single cross-sectional study design was used. The study formed part of the THUSA BANA project. The total study population of the THUSA BANA project comprised of 1257 randomly selected subjects, aged 10-15 y. Stunting was described as the height below the 5th percentile for age using the CDC standard percentiles. Furthermore, the definitions of overweight and obesity according to the International Obesity Task Force (IOTF) were used, where the cutoff points for body mass index (BMI) corresponds with the adult BMI of 25 and 30, respectively. Anthropometrical variables namely triceps (TSF) and subscapular skinfolds (SSF), waist circumference, weight, height and BMI of the 10-15-y-old subjects were analysed. Stunting was most prevalent in the rural areas (girls 23.7% and boys 26.7%) compared with urban areas (girls 11.6%, boys 17.1%). The odds ratio an...
South African Medical Journal, 2015
Early nutrition has been identified as an impor tant contributing factor to longterm health. Undernutrition, i.e. underweight, stunting, wasting and deficiencies of essential micronutrients, during this period has shortterm consequences (i.e. increased risk of morbidity, mortality and disability) as well as longterm consequences (influencing adult size, intellectual ability, economic productivity, reproductive performance and metabolic and cardiovascular disease). [1] Stunting, specifically in the first 2 years of life, is associated with shorter adult height, lower achievements at school, reduced adult income, and decreased birth weight in offspring. [2] The other side of the malnutrition coin is the effect of overnutrition, which includes overweight and obesity. According to the Centers for Disease Control and Prevention, [3] the shortterm health consequences of childhood obesity include an increased risk of cardiovascular disease (CVD), impaired glucose tolerance, insulin resistance, type 2 diabetes, respiratory morbidity, musculoskeletal discomfort, hepatic steatosis, gallstones and gastrooesophageal reflux, as well as impaired psychological and social function. In the long term, obese children are at a substantially higher risk of becoming obese adults, [3] with the attendant higher risk of developing noncommunicable diseases (NCDs) in adulthood. A systematic review [4] highlighted the complexity of the relationship between childhood (including adolescent) body mass index (BMI) and adult disease risk, and concluded that: (i) obese children growing into obese adults were at higher risk of NCDs in their adult years; (ii) obese children growing into normalweight adults were not at greater risk of CVD in adulthood; and (iii) interestingly, children at the bottom range of BMI who became obese adults seemed most susceptible to the risks associated with adult obesity, in particular hypertension. Similarly, children who experienced undernutrition in the first 2 years of life and who thereafter rapidly gained weight during childhood or adolescence had an increased risk of chronic disease related to nutrition. [2] It is therefore crucial to understand the relationship between early childhood undernutrition and obesity in the ensuing life stages to ultimately reduce the risk of chronic diseases. This article therefore aims to determine the prevalence of, and the relationship between, stunting and overweight among a specific group of children in South Africa (SA). Methods The second SA National Food Consumption Survey-Fortification Baseline I (NFCSFBI), conducted in 2005, provided the
South African Journal of Clinical Nutrition
Background: The objective was to compare the body composition of black stunted, and non-stunted, children, from two rural communities in South Africa, and investigate whether increased total and central adiposity is found in stunted children. The design was a cross-sectional study. The setting was two study populations of children in rural South Africa. The subjects were 351 children aged 10-15 years old [Transition and Health during Urbanisation of South Africans (THUSA BANA) study], and 1 760 children aged 6-13 years old [Ellisras Longitudinal Growth and Health Study (ELS)]. Method: The body mass index (BMI), BMI for age z-score, sum of triceps and subscapular skin folds (SSF), waist circumference (WC), waist:height ratio (WHtR) of stunted, and non-stunted, children, were compared. Results: Almost 10% (n = 203) of children were stunted, and 34% had a BMI for age z-score below -2. After adjustment for age, non-stunted children had significantly higher values for BMI and WC, in both...
BMC Public Health, 2010
Background: Low-to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases. This study aimed to investigate the prevalence and patterns of stunting and overweight/obesity, and hence risk for metabolic disease, in a group of children and adolescents in rural South Africa. Methods: A cross-sectional growth survey was conducted involving 3511 children and adolescents 1-20 years, selected through stratified random sampling from a previously enumerated population living in Agincourt subdistrict, Mpumalanga Province, South Africa. Anthropometric measurements including height, weight and waist circumference were taken using standard procedures. Tanner pubertal assessment was conducted among adolescents 9-20 years. Growth z-scores were generated using 2006 WHO standards for children up to five years and 1977 NCHS/WHO reference for older children. Overweight and obesity for those <18 years were determined using International Obesity Task Force BMI cut-offs, while adult cut-offs of BMI ≥ 25 and ≥ 30 kg/m 2 for overweight and obesity respectively were used for those ≥ 18 years. Waist circumference cut-offs of ≥ 94 cm for males and ≥ 80 cm for females and waist-to-height ratio of 0.5 for both sexes were used to determine metabolic disease risk in adolescents.
Combined stunting and overweight in young children - a paradox?
The South African journal of clinical nutrition : SAJCN : the official journal of the South African Society of Parenteral and Enteral Nutrition and the Association for Dietetics in South Africa, 2006
The paper by Mamabolo and co-workers1 in this issue of the Journal raises some important questions around the pathogenesis and significance of stunting and apparent obesity in young children in rural South Africa, and the long-term consequences related to these. It has been established clearly in a number of studies conducted in South Africa (including the current one) that stunting is the major clinical form of undernutrition present in children in many parts of the country, with nearly 20% being stunted by 2 years of age. The current study found a very high prevalence of stunting (48%) at 3 years of age, rising from 35% at 1 year, in a longitudinal sample of children living in villages in the central region of Limpopo province.2 This compares with a figure of 16% stunting at 2 years of age in children from the Birth to Twenty cohort in Johannesburg.3 The possibly more surprising finding in the Limpopo children was the high prevalence of overweight and obesity in the stunted children at 3 years of age, which depending on the methods and cutoffs used (either body mass index (BMI) or weight-for-height z-score (WHZ)) ranged from 31% to 46%, despite the high prevalence of stunting and therefore presumed chronic undernutrition. Furthermore some 19% of the total cohort were both stunted and overweight and 40% of the overweight children were stunted. In this study children at 3 years of age were six times more likely to be overweight if they had a low WHZ score at birth. Unlike the Limpopo study, although stunting at 2 years of age in the Birth to Twenty cohort was a predictor of higher BMI, it did not predict subcutaneous fat values or fat distribution.3 Because of the lack of higher subcutaneous fat values or greater centripetal fat ratios, it was suggested that the higher BMI values were spurious and not a reflection of increased overweight or obesity, but rather due to the effect of a reduction in height on the BMI as the denominator is height squared -any reduction in height therefore dramatically increases the BMI. Support for this conclusion was also provided by finding a difference in the relationship between height and BMI in the nonstunted and stunted 2-year-old children; in the former group there was no relationship between height and BMI, while in the stunted group there was a significant inverse relationship between the two.3
Public Health Nutrition, 2005
To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa. Design: Prospective cohort study. Setting: Rural villages in the Central Region of the Limpopo Province, South Africa. Subjects: One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded. Results: Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stunted and overweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96-4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17-0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46 -34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24 -38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7-12.10). Conclusion: The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.