Longitudinal Growth and Undernutrition Burden Among Term Low Birth Weight Newborns Reared in Adverse Socioeconomic
Manpreet Kaur1, Geeta Trilok Kumar2, Sikha Sinha3
1Global Clinical Development Statistics and Data Management, Veterinary Medicine Research and Development, Zoetis, Zaventem, Belgium.
Insights
Term low birth weight infants in urban poor settings showed catch-up growth in weight and BMI, but not height, despite adverse conditions and appropriate counseling. Further evaluation of excess weight gain is needed.
Area of Science:
- Pediatrics
- Public Health
- Human Growth and Development
Background:
- Limited data exists on undernutrition incidence and recovery in term low birth weight neonates from urban poor settings.
- Understanding these patterns is crucial for targeted health and nutrition interventions.
Purpose of the Study:
- To determine the longitudinal growth and undernutrition burden among term low birth weight newborns in adverse conditions with appropriate counseling.
- To assess recovery from undernutrition and the coexistence of its different forms.
Main Methods:
- Follow-up data from the DIVIDS trial included 2079 term low birth weight newborns (1800-2499g) from an urban poor setting.
- Growth was tracked from birth to 26 weeks and again at 2.8-6.8 years using the Cole LMS approach and WHO z-scores (HAZ, WAZ, BMIZ).
- Data was adjusted for vitamin D intervention effects and attrition bias.
Main Results:
- Height-for-age z-score (HAZ) remained stable, with minimal change from birth to 7 years.
- Weight-for-age z-score (WAZ) and BMI-for-age z-score (BMIZ) showed significant catch-up growth, particularly by 26 weeks and continuing into early childhood.
- While underweight and wasting declined, 60-92% experienced at least one form of undernutrition, and half remained stunted by age 5.
Conclusions:
- Term low birth weight infants in adverse socioeconomic settings demonstrate substantial catch-up growth in WAZ and BMIZ with parental counseling, but not HAZ.
- The long-term implications of disproportionate weight gain relative to length require further investigation.
Background:
There is limited data in term low birth weight neonates from urban poor settings on the incidence of and recovery from undernutrition and co-existence of its different forms, under conditions of appropriate health and nutrition care counselling.
Objectives:
To determine the longitudinal growth and undernutrition burden among term low birth weight newborns reared in adverse conditions, but with appropriate counselling.
Methods:
The study reports follow-up data from DIVIDS trial. 2079 term low birth weight (1800-2499 grams) newborns from an urban poor setting were followed-up for growth from 0 to 26 weeks (n=1282) and at 2.8-6.8 years (n=912). Using Cole LMS approach, age- and sex-specific internal z scores were computed and subsequently adjusted for the effect of a vitamin D intervention and potential bias due to attrition. Back-transformed measurements were then used to compute WHO z scores for height for age (HAZ), weight for age (WAZ), and BMI for age (BMIZ).
Results:
HAZ remained fairly stable: mean changes from birth till 6 weeks, 26 weeks and 3-7 years were 0.07, 0.04 and 0.2 SD, respectively. BMIZ and WAZ showed considerable catch-up; 0.69 SD, 1.84 SD and 1.38 SD for BMIZ, and 0.25 SD, 0.89 SD and 0.60 SD for WAZ, respectively. 60-92% had at least one form of undernutrition and co-existence was frequent. Half the children remained stunted till 5 years, while underweight and wasting declined considerably from 0-6 months.
Conclusion:
With appropriate counselling of parents, term low birth weight infants reared under adverse socioeconomic conditions show substantial catch-up growth in BMIZ and WAZ but not in HAZ. The long-term consequences of this excess weight over length gain need focused evaluation.
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