Date Published: April 11, 2018
Publisher: Public Library of Science
Author(s): Emanuella De Lucia Rolfe, Giovanny Vinícius Araújo de França, Carolina Avila Vianna, Denise P. Gigante, J. Jaime Miranda, John S. Yudkin, Bernardo Lessa Horta, Ken K. Ong, C. Mary Schooling.
Early life stunting may have long-term effects on body composition, resulting in obesity-related comorbidities. We tested the hypothesis that individuals stunted in early childhood may be at higher cardiometabolic risk later in adulthood. 1753 men and 1781 women participating in the 1982 Pelotas (Brazil) birth cohort study had measurements of anthropometry, body composition, lipids, glucose, blood pressure, and other cardiometabolic traits at age 30 years. Early stunting was defined as height-for-age Z-score at age 2 years below -2 against the World Health Organization growth standards. Linear regression models were performed controlling for sex, maternal race/ethnicity, family income at birth, and birthweight. Analyses were stratified by sex when p-interaction<0.05. Stunted individuals were shorter (β = -0.71 s.d.; 95% CI: -0.78 to -0.64), had lower BMI (β = -0.14 s.d.; 95%CI: -0.25 to -0.03), fat mass (β = -0.28 s.d.; 95%CI: -0.38 to -0.17), SAFT (β = -0.16 s.d.; 95%CI: -0.26 to -0.06), systolic (β = -0.12 s.d.; 95%CI: -0.21 to -0.02) and diastolic blood pressure (β = -0.11 s.d.; 95%CI: -0.22 to -0.01), and higher VFT/SAFT ratio (β = 0.15 s.d.; 95%CI: 0.06 to 0.24), in comparison with non-stunted individuals. In addition, early stunting was associated with lower fat free mass in both men (β = -0.39 s.d.; 95%CI: -0.47 to -0.31) and women (β = -0.37 s.d.; 95%CI: -0.46 to -0.29) after adjustment for potential confounders. Our results suggest that early stunting has implications on attained height, body composition and blood pressure. The apparent tendency of stunted individuals to accumulate less fat-free mass and subcutaneous fat might predispose them towards increased metabolic risks in later life.
The prevalence of obesity is rapidly increasing worldwide, particularly affecting low and middle-income countries, where this condition co-exists with undernutrition.[1,2] Childhood stunting is a significant global health issue, affecting 161 million children under 5 years of age in 2013. It has a complex aetiology, involving household, environmental, socioeconomic and cultural factors. Research has suggested that stunting or poor height gain in early childhood may be a critical factor in promoting later obesity and obesity-related comorbidities.[2,5,6]
Characteristics of the study population are summarised in Table 1. The mean age of the participants was 30.20years (s.d. = 0.34). Men had greater length at 2 years, attained height at 30 years of age, weight, BMI, fat-free mass, VFT, systolic and diastolic blood pressure, random glucose level, total and low-density lipoprotein (LDL), and triglycerides, but lower fat mass, subcutaneous abdominal fat, C-reactive protein, and high-density lipoproteins (HDL) than women at age 30 years.
Our results from this large, long-running, middle-income country birth cohort study suggest that stunting at age 2 years has implications on attained height, body composition and blood pressure. Consistently with the current literature, we observed that men and women with early stunting were shorter as adults than non-stunted individuals.