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. 2023 Feb;14(1):61-69.
doi: 10.1017/S2040174422000423. Epub 2022 Jul 18.

Anthropometric proxies for child neurodevelopment in low-resource settings: length- or height-for-age, head circumference or both?

Molly M Lamb  1 , Amy K Connery  2   3 , Alison M Colbert  2   3 , Desirée Bauer  4 , Daniel Olson  1   2   5 , Alejandra Paniagua-Avila  4   6 , Diva M Calvimontes  4 , Guillermo Antonio Bolaños  4 , Hana M El Sahly  7 , Flor M Muñoz  7   8 , Edwin J Asturias  1   2   5
Affiliations

Anthropometric proxies for child neurodevelopment in low-resource settings: length- or height-for-age, head circumference or both?

Molly M Lamb et al. J Dev Orig Health Dis. 2023 Feb.

Abstract

Stunting (<-2 SD of length- or height-for-age on WHO growth curves) is the most used predictor of child neurodevelopmental (ND) risk. Occipitofrontal head circumference (OFC) may be an equally feasible, but more direct and robust predictor. We explored association of the two measurements with ND outcome, separately and combined, and examined if cutoffs are more efficacious than continuous measures in predicting ND risk. Infants and young children in rural Guatemala (n = 642; age range = 0.1-35.9 months) were enrolled in a prospective natural history study, and their ND was tested using the Mullen Scales of Early Learning (MSEL) longitudinally. Length- or height-for-age and OFC-for-age were calculated. We performed age-adjusted multivariable regression analyses to explore the association between 1) length or height and ND, 2) OFC and ND, and 3) both length or height and OFC combined, with ND; concurrently, predictively, and longitudinally, as continuous variables and using WHO z-score cutoffs. Continuous length- or height-for-age and OFC z-scores were more strongly associated with MSEL than the traditional -2 SD WHO cutoff. The combination of height-for-age z-score and OFC z-score was consistently, strongly associated with the MSEL Early Learning Composite concurrently (p-values 0.0004-0.11), predictively (p-value 0.001-0.07), with the exception of the 18-24 months age group which had very few records, and in the longitudinal model (p-value <0.0001-0.004). The combination of continuous length- or height-for-age and OFC shows additional utility in estimating ND risk in infants and young children. Measurement of OFC may improve precision of prediction of ND risk in infants and young children.

Keywords: Head circumference; low-resource settings; neurodevelopment; stunting; young children.

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Conflict of interest statement

Conflicts of Interest

None.

Figures

Figure 1:
Figure 1:
Percentage of Children with Stunting*, Microcephaly*, Both Conditions, and Neither Condition by Age Group in a Cohort of Infants and Young Children in Rural Southwest Guatemala. *> 2SD below the mean on the WHO growth chart
See this image and copyright information in PMC

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