Associations of stunting at 2 years with body composition and blood pressure at 8 years of age: longitudinal cohort analysis from lowland Nepal

Abstract

Background: Stunting remains a very common form of child malnutrition worldwide, particularly in South Asian populations. There is poor understanding of how it develops and how it is associated with subsequent phenotype.

Subjects/methods: We used data from a longitudinal cohort of children (n = 841) in lowland Nepal to investigate associations of stunting at 2 years with maternal traits and early growth patterns, and with body size and composition, kidney dimensions by ultrasound, lung function by spirometry and blood pressure (BP) at 8 years.

Results: Compared to non-stunted children, children stunted at 2 years came from poorer families and had shorter, lighter mothers. They tended to have higher birth order, were born smaller, and remained shorter, lighter and thinner at 8 years. They had lower leg length, lean and fat masses, smaller kidneys, and reduced lung function (all p < 0.0001). These differences persisted with smaller magnitude after adjusting for current height, maternal height and education, family assets and birth order. Stunting was not associated with BP.

Discussion: Stunting developed on an inter-generational timescale in this population and its risk increased with birth order. At 8 years, children stunted at 2 years had deficits in tissue masses and some aspects of physical function that were only partially attributable to their persisting short height and maternal phenotype. This suggests that the early stunting is associated with greater deficits in long-term outcomes than would be expected from the persistent short stature alone.

Fig. 1

Deficits in individual body components of stunted children, relative to non-stunted children, expressed in sympercents. Error bars are standard error of the group difference

Fig. 2

Association of high adiposity with systolic blood pressure at 8 years, stratified by presence/absence of stunting at 2 years. Children were categorised as having ‘normal’ or ‘high’ subscapular skinfold at 8 years, using a cut-off of 5.0 mm. Relative to normal adiposity, high adiposity was associated with higher BP in stunted children, but not in non-stunted children, however this group difference did not achieve statistical significance