Stunting, overweight and child development impairment go hand in hand as key problems of early infancyuruguayan case

Resumen

Background: Stunting, overweight and child development impairment are key problems affecting early infancy and have short and long-term consequences on academic performance, social competence and adult health. Objective: The aim of this Thesis is to identify linkages between stunting, overweight and child development impairment as well as to examine their evolution in the last ten years in Uruguay. Study design: We analysed data from 5 surveys carried out in Uruguay. We studied 2,069 children < 5 years old in Canelones, Uruguay (2007) and four large national samples representative of national and regional level of infants 0-23 months cared by Integral Health System in Uruguay 1999 (N=2,571), 2003 (N=2,783), 2007 (N=3,003) and 2011 (N=2,994). The strength of this study is the robust samples sizes as well as that children included in the analysis were from different socio¿economic Uruguayan families. The main limitation of this Thesis is the fact that, we analyse cross sectional data with only one measure per child, so we only could describe association and not to establish causal relationship. Results: We observed high prevalence of overweight 14.9% (13.7%-16.9%); child development impairment 10.3% (8.9% - 11.7%) and stunting 8.0% in children < 5 years. No changes in low birth weight (LBW) prevalence 8.3% (7.8-8.8%) or macrosomia 6.3% (5.9-6.7%) were observed in the last decade. The highest prevalence of stunting (16%) was detected during the first 12 months of life, in this stage infants were three times more likely to be stunted than children from one to five years. Stunting fell 2.7% in the last decade. The highest rate of being overweight (21%) was observed from 6 to 24 months. Stunting and overweight rates decreased with age. On the other hand, the discrepancy between the current developmental levels and what they would have achieved increased with age, especially in the poorest children. Low birth weight was a risk for stunting OR:3.2(1.8-5.6) and for reduced head circumference growth OR:3.9(1.9-8.0); infants with reduced head circumference had an increased chance of delayed psychomotor development OR:2.4(1.17-5.07) and of being stunted OR:3.2 (1.7-6.3); stunted infants had almost three times risk of being overweight OR: 2.7(1.8-4.1). Maternal stature < 160 cm, low BMI, low education and poverty were also predictor for stunting. Obese mother, maternal stature >160 cm and maternal smoking increased chance of overweight. Some maternal behavioural, such as mother not use to sing songs and maternal smoking increased the likelihood of delaying psychomotor development.Intrauterine smoke exposure increased chance of stunting OR:1.5(1.1-2.1) and anaemia OR:1.9(1.1-3.0) in infants under 24 months. Conclusion: The close linkages between stunting, being overweight and child development impairment suggest they should be targeted together: they coexist in the same infants and predict each other.