Catch-up growth occurs after diarrhea in early childhood.
Diarrhea and linear growth faltering continue to burden low-income countries and are among the most important contributors to poor health during early childhood. Diarrhea is thought to adversely affect linear growth, but catch-up growth can occur if no additional insults are experienced. We sought to characterize catch-up growth in relation to diarrhea burden in a multisite dataset of 1007 children. Using longitudinal anthropometry and diarrheal surveillance data from 7 cohort studies in 4 countries, we examined the relation between diarrhea prevalence and growth in 3- to 6-mo periods using linear mixed-effect models. Growth during each period was calculated as a function of age using linear splines. We incorporated the longitudinal prevalence of diarrhea in both current and previous periods into the model. Diarrhea during the current period was associated with slower linear and ponderal growth. Faster (catch-up) growth in length was observed in children with no diarrhea in age groups immediately after an age group in which diarrhea was experienced [age group >6-12 mo: 0.03 mm/mo for each percentage diarrhea prevalence in the previous period (95% CI: 0.007, 0.06) relative to 11.3 mm/mo mean growth rate; age group >12-18 mo: 0.04 mm/mo (95% CI: 0.02, 0.06) relative to 8.9 mm/mo mean growth rate; age group >18-24 mo: 0.04 mm/mo (95% CI: 0.003, 0.09) relative to 7.9 mm/mo mean growth rate]. The associations were stronger in boys than in girls when separate models were run. Similar results were observed when weight was the outcome variable. When diarrheal episodes are followed by diarrhea-free periods in the first 2 y of life, catch-up growth is observed that may allow children to regain their original trajectories. The finding of a greater effect of diarrhea on linear growth in boys than in girls was unexpected and requires additional study. Diarrhea burdens are high throughout the first 2 y of life in these study sites, therefore reducing the likelihood of catch-up growth. Extending diarrhea-free periods may increase the likelihood of catch-up growth and decrease the prevalence of stunting.
Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Heath, Johns Hopkins University, Baltimore, MD Fogarty International Center, National Institutes of Health, Bethesda, MD.
Stephanie A
SA
Richard
Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Heath, Johns Hopkins University, Baltimore, MD.
Robert E
RE
Black
Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Heath, Johns Hopkins University, Baltimore, MD.
Robert H
RH
Gilman
Center for Global Health, University of Virginia School of Medicine, Charlottesville, VA.
Richard L
RL
Guerrant
Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Gagandeep
G
Kang
Instituto de Investigación Nutricional, Lima, Peru; and.
Claudio F
CF
Lanata
Epidemiology Division, Statens Serum Institut, Copenhagen, Denmark.
Kåre
K
Mølbak
Fogarty International Center, National Institutes of Health, Bethesda, MD.
Zeba A
ZA
Rasmussen
Fogarty International Center, National Institutes of Health, Bethesda, MD.
R Bradley
RB
Sack
Epidemiology Division, Statens Serum Institut, Copenhagen, Denmark.
Palle
P
Valentiner-Branth
Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Heath, Johns Hopkins University, Baltimore, MD wcheckl1@jhmi.edu.
William
W
Checkley
D001827:Body Height; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012016:Reference Values; D015430:Weight Gain / Q000502:physiology