Early childhood growth improves adult health outcomes in developing countries

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1. Linear growth and relative weight gain before age two are both positively associated with key human capital outcomes in adulthood – including height and years of schooling attained.  

2. These positive associations diminish around age two, at which point increased relative weight gain may contribute to increased cardiometabolic disease risk. 

Among children with growth failure in developing countries, the “catch up dilemma” refers to two conflicting associations; though fast weight gain early in life has been linked to adult cardiometabolic disease, poor weight gain is known to lead to impaired cognitive development and increased morbidity and mortality. This study demonstrates that increased birthweight and faster linear growth in the first two years of life are positively associated with key aspects of human capital – namely, schooling and adult height – with a potential protective effect against adult chronic disease risk factors. After age two, however, rapid relative weight gain has little benefit to human capital and should be avoided. These associations do not prove causation, but have many practical implications for low- and middle-income countries. The challenge is now to develop interventions that promote increased birthweight and childhood linear growth in the first 1000 days of life but prevent rapid relative weight gain beyond this critical period.

Click to read the study in The Lancet

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Image: PD

1. Linear growth and relative weight gain before age two are both positively associated with key human capital outcomes in adulthood – including height and years of schooling attained.  

2. These positive associations diminish around age two, at which point increased relative weight gain may contribute to increased cardiometabolic disease risk. 

This [prospective cohort] study analyzed data from five birth cohort studies in low and middle income countries (Brazil, Guatemala, India, the Philippines, and South Africa) to determine how linear growth and relative weight gain during infancy and childhood relate to health and human capital outcomes in young adults.

Using data from 8362 participants, the authors found that higher birthweight and faster linear growth were both associated with reduced risk of not completing secondary school (odds ratio 0.82, 95% CI 0.78-0.87 and 0.74, 0.67-0.78 respectively). Though faster linear growth and relative weight gain were both slightly associated with increased risk of adult overweight and elevated blood pressure, neither were associated with dysglycemia; higher birthweight was associated with lower risk of dysglycemia (0.89, 0.81-0.98).  Faster relative weight gain in the first two years of life was predictive of adult fat-free mass, but had little relation to cardiometabolic risk factors.

In sum: Among children with growth failure in developing countries, the “catch up dilemma” refers to two conflicting associations; though fast weight gain early in life has been linked to adult cardiometabolic disease, poor weight gain is known to lead to impaired cognitive development and increased morbidity and mortality. This study demonstrates that increased birthweight and faster linear growth in the first two years of life are positively associated with key aspects of human capital – namely, schooling and adult height – with a potential protective effect against adult chronic disease risk factors. After age two, however, rapid relative weight gain has little benefit to human capital and should be avoided. These associations do not prove causation, but have many practical implications for low- and middle-income countries. The challenge is now to develop interventions that promote increased birthweight and childhood linear growth in the first 1000 days of life but prevent rapid relative weight gain beyond this critical period.

Click to read the study in The Lancet  

By Elizabeth Kersten and Andrew Bishara

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