Linear growth trajectories in Zimbabwean infants.
Undernutrition in early life underlies 45% of child deaths globally. Stunting malnutrition (suboptimal linear growth) also has long-term negative effects on childhood development. Linear growth deficits accrue in the first 1000 d of life. Understanding the patterns and timing of linear growth faltering or recovery during this period is critical to inform interventions to improve infant nutritional status.



We aimed to identify the pattern and determinants of linear growth trajectories from birth through 24 mo of age in a cohort of Zimbabwean infants.



We performed a secondary analysis of longitudinal data from a subset of 3338 HIV-unexposed infants in the Zimbabwe Vitamin A for Mothers and Babies trial. We used k-means clustering for longitudinal data to identify linear growth trajectories and multinomial logistic regression to identify covariates that were associated with each trajectory group.



For the entire population, the mean length-for-age z score declined from -0.6 to -1.4 between birth and 24 mo of age. Within the population, 4 growth patterns were identified that were each characterized by worsening linear growth restriction but varied in the timing and severity of growth declines. In our multivariable model, 1-U increments in maternal height and education and infant birth weight and length were associated with greater relative odds of membership in the least-growth restricted groups (A and B) and reduced odds of membership in the more-growth restricted groups (C and D). Male infant sex was associated with reduced odds of membership in groups A and B but with increased odds of membership in groups C and D.



In this population, all children were experiencing growth restriction but differences in magnitude were influenced by maternal height and education and infant sex, birth weight, and birth length, which suggest that key determinants of linear growth may already be established by the time of birth. This trial was registered at clinicaltrials.gov as NCT00198718.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
Ethan K
EK
Gough
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
Erica Em
EE
Moodie
Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.|Blizard Institute, Queen Mary University of London, London, United Kingdom.
Andrew J
AJ
Prendergast
Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.
Robert
R
Ntozini
Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and.
Lawrence H
LH
Moulton
Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and.
Jean H
JH
Humphrey
School of Population and Public Health, University of British Columbia, Vancouver, Canada amee.manges@ubc.ca.
Amee R
AR
Manges
D001724:Birth Weight; D001827:Body Height; D002657:Child Development; D002675:Child, Preschool; D016000:Cluster Analysis; D015331:Cohort Studies; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D015658:HIV Infections; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D009752:Nutritional Status; D012959:Socioeconomic Factors; D014801:Vitamin A / Q000008:administration & dosage; D015030:Zimbabwe
D014801:Vitamin A
children; infants; longitudinal; malnutrition; prenatal; stunting