Birth-to-childhood tracking of linear growth and weight gain in the MINA-Brazil Study

Lourenço, Bárbara Hatzlhoffer; Rodrigues, Caroline Zani; Damasceno, Ana Alice de Araújo; Cardoso, Marly Augusto; Castro, Marcia C.

doi:10.11606/s1518-8787.2023057005628

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Original Article • Rev. Saúde Pública 57 (Suppl 2) • 2023 • https://doi.org/10.11606/s1518-8787.2023057005628 copy

Birth-to-childhood tracking of linear growth and weight gain in the MINA-Brazil Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth.

METHODS:

Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25^th, 50^th, and 75^th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models.

RESULTS:

Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50^th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50^th quantile: 0.31, 95%CI: 0.19 to 0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25^th quantile: 0.30, 95%CI: 0.13 to 0.56), and during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75^th quantile: 0.59, 95%CI: 0.35 to 0.83) and during childhood (75^th quantile: 0.54, 95%CI: 0.15 to 0.93).

CONCLUSION:

There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition.

DESCRIPTORS:
Child; Nutritional Status; Growth; Weight Gain; Socioeconomic Factors; Birth Cohort

Characteristic		n	Median (IQR) or %
Sex
	Female	297	48.4
	Male	317	51.6
Gestational age at birth (weeks)		614	39.7 (39, 40)
Birth length (cm)		613	49 (48, 51)
Birth length for gestational age (z-score)^a a Calculated according to the INTERGROWTH-21st Project standards for newborn size by gestational age and sex.		613	0.06 (-0.58 to 0.86)
Birth length classification^a a Calculated according to the INTERGROWTH-21st Project standards for newborn size by gestational age and sex.
	< −2 z-scores	600	97.9
	≥ -2 z-scores	13	2.1
Birth weight (kg)		614	3.31 (3.05 to 3.62)
Birth weight for gestational age (z-score)^a a Calculated according to the INTERGROWTH-21st Project standards for newborn size by gestational age and sex.		614	0.18 (-0.48 to 0.87)
Birth weight classification^a a Calculated according to the INTERGROWTH-21st Project standards for newborn size by gestational age and sex.
	< -2 z-scores	4	0.6
	≥ -2 and ≤+2 z-scores	588	95.8
	> +2 z-scores	22	3.6
Household wealth at birth
	Highest	286	46.6
	Intermediate	230	37.4
	Lowest	98	16.0
Age in childhood (years)		614	5.2 (5.1 to 5.4)
Height in childhood (m)		613	1.12 (1.08 to 1.15)
Height for age in childhood (z-score)^b b Calculated according to the WHO Child Growth Standards by age and sex.		613	0.06 (-0.67 to 0.78)
Height classification in childhood^b b Calculated according to the WHO Child Growth Standards by age and sex.
	< -2 z-scores	599	97.7
	≥ -2 z-scores	14	2.3
Weight in childhood (kg)		614	19.4 (17.4 to 22.2)
	Weight for age in childhood (z-score)^b b Calculated according to the WHO Child Growth Standards by age and sex.	614	0.17 (-0.59 to 1.10)
Weight classification in childhood^b b Calculated according to the WHO Child Growth Standards by age and sex.
	< -2 z-scores	16	2.6
	≥ -2 and ≤ +2 z-scores	520	84.7
	> +2 z-scores	78	12.7
Household wealth in childhood
	Highest	206	33.5
	Intermediate	205	33.4
	Lowest	203	33.1
Food insecurity in childhood
	No	287	46.7
	Yes	327	53.3

Characteristic		n	Tracking coefficients and 95% confidence intervals across the distribution^a a Anthropometric indices were calculated at birth according to the INTERGROWTH-21st Project standards for newborn size by gestational age and sex and at ages two and five years according to the WHO Child Growth Standards by age and sex. ,^b b Tracking was estimated using quantile regression models separately for HAZ and WAZ. Z-scores at a later age were regressed on those from the earlier age, extracting coefficients and 95% confidence intervals at the 25th, 50th, and 75th quantiles.
Characteristic		n	Quantile 0.25	Quantile 0.50	Quantile 0.75
Birth to 5 years
	HAZ	612	0.17 (0.07 to 0.27)	0.23 (0.11 to 0.35)	0.23 (0.13 to 0.33)
	WAZ	614	0.33 (0.21 to 0.45)	0.31 (0.19 to 0.43)	0.38 (0.19 to 0.56)
Birth to 2 years
	HAZ	551	0.23 (0.12 to 0.34)	0.20 (0.10 to 0.29)	0.28 (0.16 to 0.40)
	WAZ	550	0.41 (0.29 to 0.53)	0.32 (0.21 to 0.43)	0.35 (0.21 to 0.48)
2 to 5 years
	HAZ	550	0.82 (0.75 to 0.89)	0.88 (0.82 to 0.94)	0.89 (0.84 to 0.94)
	WAZ	550	0.86 (0.80 to 0.92)	0.96 (0.89 to 1.03)	1.10 (1.00 to 1.20)

Characteristic			Tracking coefficients across the distribution at five years^a a Anthropometric indices were calculated at birth according to the INTERGROWTH-21st Project standards for newborn size by gestational age and sex to and at age five years according to the WHO Child Growth Standards by age and sex.
			Quantile 0.25		Quantile 0.50		Quantile 0.75
			Coef. (95%CI)^b b Tracking was separately estimated using quantile regression models for HAZ and WAZ. Z-scores at age five years were regressed on those from birth to extracting coefficients and 95% confidence intervals at the 25th to 50th to and 75th quantiles	p diff^c c To investigate disparities to variables of household wealth and food insecurity were interacted with z-scores at birth. P-values for difference refer to the interaction terms. Stratified analyses were performed to report HAZ and WAZ tracking coefficients by categories of socioeconomic variables.	Coef. (95%CI)^b b Tracking was separately estimated using quantile regression models for HAZ and WAZ. Z-scores at age five years were regressed on those from birth to extracting coefficients and 95% confidence intervals at the 25th to 50th to and 75th quantiles	p diff^c c To investigate disparities to variables of household wealth and food insecurity were interacted with z-scores at birth. P-values for difference refer to the interaction terms. Stratified analyses were performed to report HAZ and WAZ tracking coefficients by categories of socioeconomic variables.	Coef. (95%CI)^b b Tracking was separately estimated using quantile regression models for HAZ and WAZ. Z-scores at age five years were regressed on those from birth to extracting coefficients and 95% confidence intervals at the 25th to 50th to and 75th quantiles	p diff^c c To investigate disparities to variables of household wealth and food insecurity were interacted with z-scores at birth. P-values for difference refer to the interaction terms. Stratified analyses were performed to report HAZ and WAZ tracking coefficients by categories of socioeconomic variables.
Height-for-age z-score (HAZ)
	Household wealth at birth
		Highest	0.30 (0.13 to 0.56)	-	0.38 (0.21 to 0.55)	-	0.30 (0.16 to 0.45)	-
		Intermediate	0.04 (−0.10 to 0.18)	0.007	0.12 (−0.02 to 0.26)	0.022	0.10 (−0.11 to 0.31)	0.198
		Lowest	0.11 (−0.19 to 0.41)	0.141	0.16 (−0.14 to 0.46)	0.103	0.12 (−0.09 to 0.32)	0.255
	Household wealth in childhood
		Highest	0.41 (0.18 to 0.64)	-	0.37 (0.21 to 0.53)	-	0.35 (0.16 to 0.53)	-
		Intermediate	0.04 (−0.14 to 0.21)	0.003	0.22 (0.03 to 0.40)	0.194	0.20 (−0.02 to 0.41)	0.189
		Lowest	0.09 (−0.10 to 0.27)	0.010	0.11 (−0.07 to 0.28)	0.012	0.10 (−0.04 to 0.25)	0.014
	Food insecurity in childhood
		No	0.13 (−0.03 to 0.30)	-	0.34 (0.18 to 0.49)	-	0.32 (0.16 to 0.48)	-
		Yes	0.13 (0.01 to 0.25)	0.689	0.20 (0.06 to 0.35)	0.387	0.12 (0.00 to 0.24)	0.047
Weight-for-age z-score (WAZ)
	Household wealth at birth
		Highest	0.42 (0.23 to 0.62)	-	0.44 (0.25 to 0.63)	-	0.59 (0.35 to 0.83)	-
		Intermediate	0.33 (0.16 to 0.50)	0.550	0.20 (0.00 to 0.40)	0.019	0.03 (−0.29 to 0.34)	0.003
		Lowest	0.18 (−0.11 to 0.46)	0.192	0.19 (−0.12 to 0.51)	0.032	0.40 (−0.10 to 0.89)	0.112
	Household wealth in childhood
		Highest	0.47 (0.24 to 0.70)	-	0.67 (0.46 to 0.86)	-	0.54 (0.15 to 0.93)	-
		Intermediate	0.28 (0.08 to 0.47)	0.192	0.30 (0.11 to 0.49)	0.013	0.35 (0.05 to 0.66)	0.308
		Lowest	0.27 (0.08 to 0.46)	0.186	0.14 (−0.08 to 0.35)	<0.001	0.08 (−0.25 to 0.41)	0.031
	Food insecurity in childhood
		No	0.27 (0.07 to 0.47)	-	0.43 (0.22 to 0.65)	-	0.52 (0.25 to 0.79)	-
		Yes	0.40 (0.26 to 0.54)	0.348	0.30 (0.16 to 0.45)	0.241	0.24 (0.05 to 0.44)	0.060

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E-mail: revsp@usp.br

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[1] Correspondence: Bárbara Hatzlhoffer Lourenço Universidade de São Paulo Faculdade de Saúde Pública Departamento de Nutrição Avenida Doutor Arnaldo 715, 2° andar 01246-904 São Paulo, SP, Brasil E-mail: barbaralourenco@usp.br