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

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Abstract
Background: Low-and middle-income countries continue 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.
Keywords
preterm birth, Foetal growth restriction, stunting, wasting, childhood, RANDOMIZED CONTROLLED-TRIAL, MULTIPLE MICRONUTRIENT SUPPLEMENTATION, DOUBLE-BLIND, COHORT PROFILE, MATERNAL NUTRITION, INFANT-MORTALITY, FETAL-GROWTH, FOLLOW-UP, PREGNANCY, OUTCOMES

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MLA
Christian, Parul, Sun Eun Lee, Moira Donahue Angel, et al. “Risk of Childhood Undernutrition Related to Small-for-gestational Age and Preterm Birth in Low- and Middle-income Countries.” INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 42.5 (2013): 1340–1355. Print.
APA
Christian, P., Lee, S. E., Donahue Angel, M., Adair, L., Arifeen, S., Ashorn, P., Barros, F., et al. (2013). Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 42(5), 1340–1355.
Chicago author-date
Christian, Parul, Sun Eun Lee, Moira Donahue Angel, Linda Adair, Shams Arifeen, Per Ashorn, Fernando Barros, et al. 2013. “Risk of Childhood Undernutrition Related to Small-for-gestational Age and Preterm Birth in Low- and Middle-income Countries.” International Journal of Epidemiology 42 (5): 1340–1355.
Chicago author-date (all authors)
Christian, Parul, Sun Eun Lee, Moira Donahue Angel, Linda Adair, Shams Arifeen, Per Ashorn, Fernando Barros, Caroline Fall, Wafaie Fawzi, Wei Hao, Gang Hu, Jean Humphrey, Lieven Huybregts, Chary Joglekar, Simon Kariuki, Patrick Kolsteren, Ghattu Krishnaveni, Enqing Liu, Reynaldo Martorell, David Osrin, Lars-Ake Persson, Usha Ramakrishnan, Linda Richter, Dominique Roberfroid, Ayesha Sania, Feiko Ter Kuile, James Tielsch, Cesar Victora, Chittaranjan Yajnik, Hong Yan, Lingxia Zeng, and Robert Black. 2013. “Risk of Childhood Undernutrition Related to Small-for-gestational Age and Preterm Birth in Low- and Middle-income Countries.” International Journal of Epidemiology 42 (5): 1340–1355.
Vancouver
1.
Christian P, Lee SE, Donahue Angel M, Adair L, Arifeen S, Ashorn P, et al. Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. 2013;42(5):1340–55.
IEEE
[1]
P. Christian et al., “Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries,” INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, vol. 42, no. 5, pp. 1340–1355, 2013.
@article{4212571,
  abstract     = {Background: Low-and middle-income countries continue 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.},
  author       = {Christian, Parul and Lee, Sun Eun and Donahue Angel, Moira and Adair, Linda and Arifeen, Shams and Ashorn, Per and Barros, Fernando and Fall, Caroline and Fawzi, Wafaie and Hao, Wei and Hu, Gang and Humphrey, Jean and Huybregts, Lieven and Joglekar, Chary and Kariuki, Simon and Kolsteren, Patrick and Krishnaveni, Ghattu and Liu, Enqing and Martorell, Reynaldo and Osrin, David and Persson, Lars-Ake and Ramakrishnan, Usha and Richter, Linda and Roberfroid, Dominique and Sania, Ayesha and Ter Kuile, Feiko and Tielsch, James and Victora, Cesar and Yajnik, Chittaranjan and Yan, Hong and Zeng, Lingxia and Black, Robert},
  issn         = {0300-5771},
  journal      = {INTERNATIONAL JOURNAL OF EPIDEMIOLOGY},
  keywords     = {preterm birth,Foetal growth restriction,stunting,wasting,childhood,RANDOMIZED CONTROLLED-TRIAL,MULTIPLE MICRONUTRIENT SUPPLEMENTATION,DOUBLE-BLIND,COHORT PROFILE,MATERNAL NUTRITION,INFANT-MORTALITY,FETAL-GROWTH,FOLLOW-UP,PREGNANCY,OUTCOMES},
  language     = {eng},
  number       = {5},
  pages        = {1340--1355},
  title        = {Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries},
  url          = {http://dx.doi.org/10.1093/ije/dyt109},
  volume       = {42},
  year         = {2013},
}

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