Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries

Parul Christian, Sun Eun Lee, Moira Donahue Angel, Linda S. Adair, Shams E. Arifeen, Per Ashorn, Fernando C. Barros, Caroline H.D. Fall, Wafaie W. Fawzi, Wei Hao, Gang Hu, Jean H. Humphrey, Lieven Huybregts, Charu V. Joglekar, Simon K. Kariuki, Patrick Kolsteren, Ghattu V. Krishnaveni, Enqing Liu, Reynaldo Martorell, David OsrinLars Ake Persson, Usha Ramakrishnan, Linda Richter, Dominique Roberfroid, Ayesha Sania, Feiko O.Ter Kuile, James Tielsch, Cesar G. Victora, Chittaranjan S. Yajnik, Hong Yan, Lingxia Zeng, Robert E. Black

Research output: Contribution to journalArticlepeer-review

235 Scopus citations


Background Low- a nd middle-income countriescontinue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30-40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain. Methods Using extant longitudinal birth cohorts (n=19) with data on birthweight, gestational age and child anthropometry (12-60 months), we estimated study-specific and pooled risk estimates of stunting, wasting and underweight by small-for-gestational age (SGA) and preterm birth. Results We grouped children according to four combinations of SGA and gestational age: adequate size-for-gestational age (AGA) and preterm; SGA and term; SGA and preterm; and AGA and term (the reference group). Relative to AGA and term, the OR (95% confidence interval) for stunting associated with AGA and preterm, SGA and term, and SGA and preterm was 1.93 (1.71, 2.18), 2.43 (2.22, 2.66) and 4.51 (3.42, 5.93), respectively. A similar magnitude of risk was also observed for wasting and underweight. Low birthweight was associated with 2.5-3.5-fold higher odds of wasting, stunting and underweight. The population attributable risk for overall SGA for outcomes of childhood stunting and wasting was 20% and 30%, respectively. Conclusions This analysis estimates that childhood undernutrition may have its origins in the foetal period, suggesting a need to intervene early, ideally during pregnancy, with interventions known to reduce FGR and preterm birth.

Original languageEnglish (US)
Article numberdyt109
Pages (from-to)1340-1355
Number of pages16
JournalInternational journal of epidemiology
Issue number5
StatePublished - Oct 2013


  • Childhood
  • Foetal growth restriction
  • Preterm birth
  • Stunting
  • Wasting

ASJC Scopus subject areas

  • Epidemiology


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