Impact of linear growth-improving interventions on childhood overnutrition at 24 months: a randomized controlled...

Childhood malnutrition, both undernutrition and overnutrition, is a major health concern in many low- and middle-income countries (LMICs). Efforts to reduce early undernutrition could also lead to obesity. In an earlier study, we reported the successful impact of a package of preconception, pregnancy, postnatal, and/or early childhood interventions (health, nutrition, psychosocial support, and water, sanitation, and hygiene) delivered in the first 1000 d, on reducing stunting in low-to-middle-income populations, in comparison with routine care. However, the impact of these interventions on early body composition and subsequent overweight is not known.

The objective of this study was to estimate the effect of a package of interventions directed at preventing stunting in the first 1000 d on body composition at 1 mo and childhood overweight and/or obesity at 24 mo of age.

Infant body composition was measured by deuterium dilution at 1 mo of age, along with the prevalence of childhood overweight and/or obesity at 24 mo, defined by a body mass index-for-Age Z (BMIz) score >+2 standard deviation.

Children in the preconception, pregnancy, and early childhood intervention group and those in the pregnancy and early childhood intervention group had higher body mass index z scores than those in routine care. However, the prevalence of overweight and/or obesity was low (ranging from 0.0 to 1.3%). Pregnancy interventions significantly increased neonatal fat-free mass (mean difference 0.1 kg, 95% confidence interval [CI]: 0.01, 0.2). However, there was no significant change in fat mass.

Comprehensive interventions from preconception to early childhood improve linear growth but do not result in overweight and/or obesity at 24 mo. With better resultant linear and ponderal growth, they converge with the World Health Organization's "double-duty actions for nutrition" for LMIC settings, where childhood overweight and/or obesity is a growing concern. This trial was registered at Clinical Trials Registry - India as CTRI/2017/06/008908.