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Assessment of Child Anthropometry in a Large Epidemiologic Study
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Anthropometric proxies for child neurodevelopment in low-resource settings: length- or height-for-age, head

Molly M Lamb1, Amy K Connery2,3, Alison M Colbert2,3

  • 1Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.

Journal of Developmental Origins of Health and Disease
|July 18, 2022
PubMed

Insights

Child stunting and head circumference are key indicators of neurodevelopmental risk. Continuous measurements of both height-for-age and occipitofrontal head circumference (OFC) more accurately predict neurodevelopmental outcomes in young children than traditional cutoffs.

Area of Science:

  • Pediatric Neurodevelopment
  • Growth Monitoring
  • Child Health Indicators

Background:

  • Child stunting (<-2 SD of length- or height-for-age) is a primary predictor of neurodevelopmental (ND) risk.
  • Occipitofrontal head circumference (OFC) offers a potentially more direct and robust measure for assessing ND risk.
  • Understanding the predictive efficacy of these anthropometric measures is crucial for early identification and intervention.

Purpose of the Study:

  • To explore the association between length- or height-for-age and OFC with neurodevelopmental outcomes in infants and young children.
  • To compare the predictive power of continuous anthropometric measures versus traditional WHO z-score cutoffs for ND risk.
  • To evaluate the combined utility of height-for-age and OFC in predicting concurrent, predictive, and longitudinal ND outcomes.

Main Methods:

  • Prospective natural history study involving 642 infants and young children (0.1-35.9 months) in rural Guatemala.
  • Neurodevelopmental assessment using the Mullen Scales of Early Learning (MSEL) longitudinally.
  • Age-adjusted multivariable regression analyses were performed on continuous length- or height-for-age and OFC z-scores, and WHO z-score cutoffs.

Main Results:

  • Continuous length- or height-for-age and OFC z-scores demonstrated stronger associations with MSEL scores than the traditional -2 SD WHO cutoff.
  • The combination of continuous height-for-age z-score and OFC z-score was consistently and strongly associated with the MSEL Early Learning Composite across concurrent, predictive, and longitudinal models.
  • This combined approach showed significant utility in estimating ND risk, with p-values ranging from <0.0001 to 0.11, except for a small data group (18-24 months).

Conclusions:

  • The combination of continuous length- or height-for-age and OFC measurements provides enhanced utility for estimating neurodevelopmental risk in young children.
  • Occipitofrontal head circumference measurement may improve the precision of neurodevelopmental risk prediction in infants and young children.
  • Continuous anthropometric measures offer superior predictive value for neurodevelopmental outcomes compared to traditional z-score cutoffs.

Keywords:
Head circumferencelow-resource settingsneurodevelopmentstuntingyoung children

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