Influences on catch-up growth using relative versus absolute metrics: Evidence from the MAL-ED cohort study

Stephanie A RichardLaura E Caulfield


Background: Undernutrition in early childhood has historically been considered irreversible after 2-3 years of age and has been associated with morbidity and mortality over the short-term and poor economic and cognitive outcomes over the long-term. We used longitudinal data to determine which factors are associated with positive changes in absolute and relative differences in height and weight from the WHO Growth Standards from 24 to 60 months of age.Methods: Across six MAL-ED sites, 942 children had anthropometry data at 24 and 60 months, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9-24 months, and micronutrient status. Anthropometric changes were categorized as positive changes in height- or weight-for-age z-score (HAZ, WAZ) or their absolute difference from the growth standard median (HAD (cm), WAD (kg)), as well as recovery from stunting/underweight. Outcomes were modeled using multivariate linear regression.Results: Forty-three/34% of the children who were stunted/underweight at 24 months were no longer stunted/underweight at 60 months, Among the sites, 64-92% of children had positive changes in their HAZ, whereas 25-60% had po...Continue Reading

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