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. 2022 Jul 1;5(7):e2224417.
doi: 10.1001/jamanetworkopen.2022.24417.

Underweight in the First 2 Years of Life and Growth in Later Childhood

Courtney A South  1   2 , Charles D G Keown-Stoneman  3   4 , Catherine S Birken  2   5   6   7 , Vasanti S Malik  2   8 , Stanley H Zlotkin  2   5   7   9   10 , Jonathon L Maguire  1   2   3   6   7 ; TARGet Kids! collaboration
Collaborators, Affiliations

Underweight in the First 2 Years of Life and Growth in Later Childhood

Courtney A South et al. JAMA Netw Open. .

Abstract

Importance: Few studies have examined the association between underweight in the first 2 years and growth in later childhood in high-income countries.

Objective: To evaluate the associations of underweight in the first 2 years of life with body mass index (calculated as weight in kilograms divided by height in meters squared) z score (zBMI), weight-for-age z score (WAZ), and height-for-age z score (HAZ) from ages 2 to 10 years.

Design, setting, and participants: This prospective cohort study was conducted between February 2008 to September 2020 in The Applied Research Group for Kids! practice-based research network in Toronto, Canada. Participants included healthy children aged 0 to 10 years. Data were analyzed from October 2020 to December 2021.

Exposures: Underweight (ie, zBMI less than -2, per the World Health Organization) in the first 2 years of life.

Main outcomes and measures: The primary outcome was zBMI from ages 2 to 10 years. Linear mixed-effects models were used to account for multiple growth measures over time.

Results: A total of 5803 children were included in the primary analysis. At baseline, the mean (SD) age was 4.07 (5.62) months, 2982 (52.2%) were boys, and 550 children (9.5%) were underweight. Underweight in the first 2 years was associated with lower zBMI (difference, -0.39 [95% CI, -0.48 to -0.31]) at 10 years and lower HAZ (difference, -0.24 [95% CI, -0.34 to -0.14]) at age 2 years. Stratified by sex, at age 10 years, girls and boys with underweight in the first 2 years both had lower zBMI (girls: difference, -0.47 [95% CI, -0.59 to -0.34]; boys: difference, -0.32 [95% CI, -0.44 to -0.20]). At age 10 years, children with underweight and a lower zBMI growth rate in the first 2 years had lower zBMI (difference, -0.64 [95% CI, -0.77 to -0.53) and HAZ (difference, -0.12 [-0.24 to -0.01]), while children with underweight and a higher zBMI growth rate in the first 2 years had similar zBMI (difference, -0.11 [95% CI, -0.22 to 0.001]) and higher HAZ (difference, 0.16 [95% CI, 0.05 to 0.27]) compared with children who did not have underweight in the first 2 years.

Conclusions and relevance: In this prospective cohort study, children with underweight in the first 2 years of life had lower zBMI and HAZ in later childhood. These associations were attenuated among children with a higher growth rate in the first 2 years.

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Conflict of interest statement

Conflict of Interest Disclosures: Miss South reported receiving a grant from the Canadian Institute of Health Research (CIHR) Canada Graduate Scholarships–Master’s. Dr Maguire reported receiving grants from the CIHR, Physician Services, Ontario SPOR Support Unit, and Dairy Farmers of Canada during the conduct of the study and nonfinancial support from DDrops outside the submitted work. Dr Birken reported grants from CIHR, Heart and Stroke Foundation of Canada, Physician Services, The Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Centre for Additions and Mental Health, Ontario Child Health Support Unit, Walmart Canada, and SickKids Foundation outside the submitted work. Dr Malik reported receiving grants from the Canada Research Chair program, Canadian Foundation for Innovation, Connaught New Researcher program, and The Joannah & Brian Lawson Centre for Child Nutrition at the University of Toronto. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Participants Recruited and Included for Analysis
Implausible growth measurements were flagged if height-for-age was less than −6.0 and more than 6.0; weight-for-age was less than −6.0 and more than 5.0; and body mass index (calculated as weight in kilograms divided by height in meters squared) z score was less than −5.0 and more than 5.0. Parent body mass index was also flagged if deemed implausible for mother (<18.8 and >48.0), and father (<19.4, >42.7). Measurements were set to missing if the growth measurement from the prior or following visit was more than 2 SD above or below the outlier or if the growth measurement on the original data collection form was also an outlier. There were 368 implausible observations of child body mass index, height-for-age, weight for age, parent body mass index z scores. aAge 2 years is defined as children who attended a visit between ages 25 and 34 months. bAge 5 years is defined as children who attended a visit between ages 57 and 68 months. cAge 10 years is defined as children who attended a visit between ages 117 and 128 months.
Figure 2.
Figure 2.. Body Mass Index z Score (zBMI) and Height-for-Age z Score (HAZ) Growth From Ages 2 to 10 Years by Underweight Status, Sex, and the zBMI Growth Rate in the First 2 Years of Life
Estimates are adjusted for breastfeeding duration, birthweight, parent BMI (calculated as weight in kilograms divided by height in meters squared), parent height, maternal ethnicity, and family income. C and D are additionally adjusted for sex.
See this image and copyright information in PMC

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