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Objectives To identify factors associated with improvement ('catch-up') in height and weight from 24-60 mo of age, and to determine whether associated factors differ depending on the metric used (absolute… Click to show full abstract
Objectives To identify factors associated with improvement ('catch-up') in height and weight from 24-60 mo of age, and to determine whether associated factors differ depending on the metric used (absolute or relative difference from WHO growth standards). Methods At seven MAL-ED sites, 942 children had anthropometry data at 24 and 60 mo, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9-24 mo, and micronutrient status. Anthropometric changes were categorized in terms of positive changes in Height- or Weight for-Age Z-score (HAZ, WAZ) or their differences (HAD, WAD) and recovery from stunting/underweight, and then modeled using multivariate linear regression. Results 42% of the children were stunted at 24 or 60 mo, and 24% of the children were underweight at 24 or 60 mo. 44% of the children who were stunted at 24 mo were not at 60 mo, and 34% of those underweight at 24 mo were no longer at 60 mo. Among the sites, 49-92% of children had positive changes in their HAZ, whereas 25-60% had positive changes in HAD. Linear regression models indicate that female sex (-0.21 HAZ (95% CI -0.27, -0.15); -0.75 HAD (95% CI -1.07, -0.43)) and mean LMZ (-0.10 HAZ (95% CI -0.16, -0.04); -0.47 HAD (95% CI -0.73, -0.21)) were negatively associated with change in both HAZ and HAD, whereas maternal height was positively associated with change in both HAZ and HAD (0.09 HAZ (95% CI 0.03, 0.15); 0.45 HAD (95% CI 0.15, 0.75)). Similar relationships were identified for change in WAZ and WAD. Dietary protein density was negatively associated with change in WAZ and WAD (-0.05 WAZ (95% CI -0.09, -0.01); -0.11 WAD (95% CI -0.21, -0.01)), and plasma transferrin receptor concentration was positively associated with change in WAZ and WAD (0.02 WAZ (95% CI 0.0, 0.04); 0.04 WAD (95% CI 0.0, 0.08)). Conclusions Children in the MAL-ED study demonstrated recovery from stunting and underweight from 24 to 60 mo of age. Given the similarities in the factors associated with changes in HAZ and HAD (and WAZ and WAD), both be used as complementary approaches to characterize and explain catch-up growth during early childhood. Funding Sources The MAL-ED study was supported by the Bill & Melinda Gates Foundation, with grants to the Foundation for the NIH and NIH/FIC.