The timing of growth faltering has important implications for observational analyses of the underlying determinants of nutrition outcomes
Open accessAbstract
BACKGROUND: Growth faltering largely occurs in the first 23 months after birth and is thought to be largely determined by various harmful or protective socioeconomic conditions. Children 23 months or younger, however, have only been partially exposed to these conditions, implying that statistical associations between these conditions and child growth may be substantially smaller in samples that include younger children. OBJECTIVES: To test the prediction that associations between child anthropometric outcomes and various socioeconomic conditions are systematically different for older and younger children. METHODS: We analyzed data for 699,421 children aged 0-59 months, drawn from 125 DHS implemented between 1992 and 2014 in 57 countries. The outcome variables were height-for-age Z scores (HAZ) and stunting (HAZ<-2), and weight-for-height z scores (WHZ) and wasting (WHZ<-2). Independent variables included household wealth, parental education, maternal height, demographic factors, and exposure to WASH and health services. We used age-disaggregated regressions to examine how the associations between dependent and independent variables vary across different child age ranges. RESULTS: Non-parametric regression results reaffirmed that most linear growth faltering and wasting takes place prior to 23 months of age. Estimates of the magnitude of association with wealth, education and improved toilet use from HAZ regressions are systematically larger in the sample of children 24-59 months than in the 0-23 month or 0-59 month samples; the reverse is true for WHZ regressions. CONCLUSIONS: Previous observational analyses appear to substantially underestimate the protective impacts of a wide range of underlying determinants on stunting. Conversely, wasting rates are typically low for children 24-59 months, implying that associations between underlying conditions and wasting may be stronger for children 0-23 months of age. Such analyses should pay closer attention to age disaggregation; researchers should be aware of the age effect reported in the current study and present analysis stratified by age.
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The early acceleration in metabolism coincides with a critical early-development period in which growth often falters in nutritionally stressed populations.
“This early period of metabolic acceleration corresponds to a critical period in early development in which growth often falters in nutritionally-stressed populations (19).”
From Daily energy expenditure through the human life course (2021) · cites this paper as [19]
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Daily energy expenditure through the human life course
Pontzer, H., Yamada, Y., Sagayama, H., Ainslie, P. N., Andersen, L. F., Anderson, L. J., Arab, L., Baddou, I., Bedu-Addo, K., Blaak, E. E., et al. (2021) · Science · doi:10.1126/science.abe5017 · Cited by 583 · see citing works
- Authors
- Alderman, H., & Headey, D.
- Affiliations
- International Food Policy Research Institute (US)
- Corresponding author
- Alderman, Harold
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-04-25
- Volume
- 13
- Issue
- 4
- Pages
- e0195904
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5919068
- OpenAlex
- W2802298457
- Cited by
- 129
- References
- 35
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 16 · 2023: 14 · 2022: 26 · 2021: 16 · 2020: 20 · 2019: 13 · 2018: 3
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- IFPRI E-brary (International Food Policy Research Institute) (submittedVersion, other-oa)
- CGSPace A Repository of Agricultural Research Outputs (Consultative Group for International Agricultural Research) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- International Food Policy Research Institute (International Food Policy Research Institute) (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Funders
- Bill and Melinda Gates Foundation
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- child growth faltering, stunting, wasting, household wealth, parental education, maternal height, household sanitation, age effects, height-for-age, weight-for-height
- MeSH terms
- Anthropometry, Child Development, Child, Preschool, Female, Growth Disorders, Health Services Accessibility, Humans, Infant, Infant, Newborn, Male, Nutritional Status, Socioeconomic Factors, Models, Statistical, Age Distribution, Observational Studies as Topic
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