4.6 Article

Comparative Models of Biological and Social Pathways to Predict Child Growth through Age 2 Years from Birth Cohorts in Brazil, India, the Philippines, and South Africa

Journal

JOURNAL OF NUTRITION
Volume 148, Issue 8, Pages 1364-1371

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1093/jn/nxy101

Keywords

infant; growth failure; birth cohort; structural equation modeling; longitudinal model; social; environmental; biological

Funding

  1. Bill and Melinda Gates Foundation [OPP1164115]
  2. Wellcome Trust
  3. Indian Council of Medical Research
  4. US National Center for Health Statistics
  5. Medical Research Council (United Kingdom)
  6. British Heart Foundation
  7. US NIH
  8. Human Sciences Research Council
  9. South African Medical Research Council
  10. University of the Witwatersrand
  11. DST-NRF Centre of Excellence in Human Development
  12. Bill and Melinda Gates Foundation [OPP1164115] Funding Source: Bill and Melinda Gates Foundation

Ask authors/readers for more resources

Background: Early growth faltering accounts for one-third of child deaths, and adversely impacts the health and human capital of surviving children. Social as well as biological factors contribute to growth faltering, but their relative strength and interrelations in different contexts have not been fully described. Objective: The aim of this study was to use structural equation modelling to explore social and biological multidetermination of child height at age 2 y in longitudinal data from 4 birth cohort studies in low-and middle-income countries. Methods: We analyzed data from 13,824 participants in birth cohort studies in Brazil, India, the Philippines, and South Africa. We used exploratory structural equation models, with height-for-age at 24 mo as the outcome to derive factors, and path analysis to estimate relations among a wide set of social and biological variables common to the 4 sites. Results: The prevalence of stunting at 24 mo ranged from 14.0% in Brazil to 67.7% in the Philippines. Maternal height and birthweight were strongly predictive of height-for-age at 24 mo in all 4 sites (all P values < 0.001). Three social-environmental factors, which we characterized as child circumstances, family socioeconomic status, and community facilities, were identified in all sites. Each social-environmental factor was also strongly predictive of height-for-age at 24 mo (all P values < 0.001), with some relations partly mediated through birthweight. The biological pathways accounted for 59% of the total explained variance and the social-environmental pathways accounted for 41%. The resulting path coefficients were broadly similar across the 4 sites. Conclusions: Early child growth faltering is determined by both biological and social factors. Maternal height, itself a marker of intergenerational deprivation, strongly influences child height at 2 y, including indirect effects through birthweight and social factors. However, concurrent social factors, many of which are modifiable, directly and indirectly contribute to child growth. This study highlights opportunities for interventions that address both biological and social determinants over the long and short term.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.6
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available