Cesar G Victora1, José Villar2, Fernando C Barros3, Leila Cheikh Ismail2, Cameron Chumlea4, Aris T Papageorghiou2, Enrico Bertino5, Eric O Ohuma6, Ann Lambert2, Maria Carvalho7, Yasmin A Jaffer8, Douglas G Altman9, Julia A Noble10, Michael G Gravett11, Manorama Purwar12, Ihunnaya O Frederick13, Ruyan Pang14, Zulfiqar A Bhutta15, Stephen H Kennedy2. 1. Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil. 2. Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, England. 3. Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil3Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil. 4. Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio. 5. Dipartimento di Scienze della Sanita Pubblica e Pediatriche, Struttura Complessa di Neonatologia Universitaria, Università degli Studi di Torino, Torino, Italy. 6. Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, England6Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, Engla. 7. Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya. 8. Department of Family and Community Health, Ministry of Health, Muscat, Sultanate of Oman. 9. Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, England. 10. Department of Engineering Science, University of Oxford, Oxford, England. 11. Global Alliance to Prevent Prematurity and Stillbirth, Seattle Children's Hospital, Seattle, Washington. 12. Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India. 13. Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington. 14. School of Public Health, Peking University, Beijing, China. 15. Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan 15Center for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
IMPORTANCE: Stunting (short length for age) and wasting (low body mass index [BMI] for age) are widely used to assess child nutrition. In contrast, newborns tend to be assessed solely based on their weight. OBJECTIVE: To use recent international standards for newborn size by gestational age to assess how stunted and wasted newborns differ in terms of risk factors and prognoses. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study with follow-up until hospital discharge was conducted at urban sites in Brazil, China, India, Italy, Kenya, Oman, England, and the United States that are participating in the INTERGROWTH-21st Project. The study was conducted from April 27, 2009, to March 2, 2014, and the final dataset for analyses was locked on March 19, 2014. EXPOSURES: Sociodemographic and behavioral maternal risk factors, previous pregnancy history, and maternal and fetal conditions during pregnancy were investigated as risk factors for stunting and wasting. Anthropometry at birth was used to predict for neonatal prognosis. MAIN OUTCOMES AND MEASURES: Newborn stunting and wasting were defined as birth length and BMI for gestational age below the third centiles of the INTERGROWTH-21st standards. Prognosis was assessed through mortality before hospital discharge, admission to neonatal intensive care units, and newborn complications. RESULTS: From the 60 206 singleton live births during the study period, we selected all newborns between 33 weeks' and 42 weeks 6 days' gestation at birth (51 200 [85%]) with reliable ultrasound dating. Stunting affected 3.8% and wasting 3.4% of all newborns; both conditions were present in 0.7% of the sample. Of the 26 conditions studied, five were more strongly associated with stunting than with wasting (reported as odds ratios [OR]; 95% CI): short maternal height (6.7; 5.1-9.0), younger maternal age (0.7; 0.5-0.9), smoking (2.8; 2.3-3.3), illicit drug use (2.3; 1.5-3.6), and clinically suspected intrauterine growth restriction (5.2; 4.5-6.0). Wasting was more strongly related than stunting with 4 newborn outcomes (neonatal intensive care stay, 6.7 [5.5-8.1]; respiratory distress syndrome, 4.0 [3.3-4.9]; transient tachypnea, 2.1 [1.5-2.9]; and no oral feeding for >24 hours, 5.0 [3.9-6.5]). Maternal gestational diabetes mellitus was protective against wasting (0.6; 0.5-0.8) but not against stunting (0.9; 0.7-1.1). CONCLUSIONS AND RELEVANCE: Although newborn stunting and wasting share some common determinants, they are distinct phenotypes with their own risk factors and neonatal prognoses. To be consistent with the literature on infant and child nutrition, newborns should be classified using the 2 phenotypes of stunting and wasting. The distinction will help to prioritize preventive interventions and focus the management of fetal undernutrition.
IMPORTANCE: Stunting (short length for age) and wasting (low body mass index [BMI] for age) are widely used to assess child nutrition. In contrast, newborns tend to be assessed solely based on their weight. OBJECTIVE: To use recent international standards for newborn size by gestational age to assess how stunted and wasted newborns differ in terms of risk factors and prognoses. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study with follow-up until hospital discharge was conducted at urban sites in Brazil, China, India, Italy, Kenya, Oman, England, and the United States that are participating in the INTERGROWTH-21st Project. The study was conducted from April 27, 2009, to March 2, 2014, and the final dataset for analyses was locked on March 19, 2014. EXPOSURES: Sociodemographic and behavioral maternal risk factors, previous pregnancy history, and maternal and fetal conditions during pregnancy were investigated as risk factors for stunting and wasting. Anthropometry at birth was used to predict for neonatal prognosis. MAIN OUTCOMES AND MEASURES: Newborn stunting and wasting were defined as birth length and BMI for gestational age below the third centiles of the INTERGROWTH-21st standards. Prognosis was assessed through mortality before hospital discharge, admission to neonatal intensive care units, and newborn complications. RESULTS: From the 60 206 singleton live births during the study period, we selected all newborns between 33 weeks' and 42 weeks 6 days' gestation at birth (51 200 [85%]) with reliable ultrasound dating. Stunting affected 3.8% and wasting 3.4% of all newborns; both conditions were present in 0.7% of the sample. Of the 26 conditions studied, five were more strongly associated with stunting than with wasting (reported as odds ratios [OR]; 95% CI): short maternal height (6.7; 5.1-9.0), younger maternal age (0.7; 0.5-0.9), smoking (2.8; 2.3-3.3), illicit drug use (2.3; 1.5-3.6), and clinically suspected intrauterine growth restriction (5.2; 4.5-6.0). Wasting was more strongly related than stunting with 4 newborn outcomes (neonatal intensive care stay, 6.7 [5.5-8.1]; respiratory distress syndrome, 4.0 [3.3-4.9]; transient tachypnea, 2.1 [1.5-2.9]; and no oral feeding for >24 hours, 5.0 [3.9-6.5]). Maternal gestational diabetes mellitus was protective against wasting (0.6; 0.5-0.8) but not against stunting (0.9; 0.7-1.1). CONCLUSIONS AND RELEVANCE: Although newborn stunting and wasting share some common determinants, they are distinct phenotypes with their own risk factors and neonatal prognoses. To be consistent with the literature on infant and child nutrition, newborns should be classified using the 2 phenotypes of stunting and wasting. The distinction will help to prioritize preventive interventions and focus the management of fetal undernutrition.
Authors: Irene Esteban-Cornejo; Pontus Henriksson; Cristina Cadenas-Sanchez; Jérémy Vanhelst; Maria Forsner; Frederic Gottrand; Mathilde Kersting; Luis A Moreno; Jonatan R Ruiz; Kurt Widhalm; Francisco B Ortega Journal: Matern Child Nutr Date: 2017-04-11 Impact factor: 3.092
Authors: Jamie L Dorsey; Swetha Manohar; Sumanta Neupane; Binod Shrestha; Rolf D W Klemm; Keith P West Journal: Matern Child Nutr Date: 2017-02-23 Impact factor: 3.092
Authors: Ty Beal; Danh Tuyen Le; Thi Huong Trinh; Dharani Dhar Burra; Tuyen Huynh; Thanh Thi Duong; Tuyet Mai Truong; Duy Son Nguyen; Kien Tri Nguyen; Stef de Haan; Andrew D Jones Journal: Matern Child Nutr Date: 2019-05-02 Impact factor: 3.092
Authors: José Villar; Fabien A Puglia; Tanis R Fenton; Leila Cheikh Ismail; Eleonora Staines-Urias; Francesca Giuliani; Eric O Ohuma; Cesar G Victora; Peter Sullivan; Fernando C Barros; Ann Lambert; Aris T Papageorghiou; Roseline Ochieng; Yasmin A Jaffer; Douglas G Altman; Alison J Noble; Michael G Gravett; Manorama Purwar; Ruyan Pang; Ricardo Uauy; Stephen H Kennedy; Zulfiqar A Bhutta Journal: Pediatr Res Date: 2017-05-31 Impact factor: 3.756
Authors: Stephen H Kennedy; Cesar G Victora; Ricardo Uauy; Zulfiqar A Bhutta; José Villar; Rachel Craik; Stephen Ash; Fernando C Barros; Hellen C Barsosio; James A Berkley; Maria Carvalho; Michelle Fernandes; Leila Cheikh Ismail; Ann Lambert; Cecilia M Lindgren; Rose McGready; Shama Munim; Christoffer Nellåker; Julia A Noble; Shane A Norris; Francois Nosten; Eric O Ohuma; Aris T Papageorghiou; Alan Stein; William Stones; Chrystelle O O Tshivuila-Matala; Eleonora Staines Urias; Manu Vatish; Katharina Wulff; Ghulam Zainab; Krina T Zondervan Journal: Gates Open Res Date: 2019-02-05
Authors: Mariangela F Silveira; Alicia Matijasevich; Ana Maria B Menezes; Bernardo L Horta; Ina S Santos; Aluisio J D Barros; Fernando C Barros; Cesar G Victora Journal: BMJ Open Date: 2016-02-01 Impact factor: 2.692