Weight gain in the first two years of life is an important predictor of schooling outcomes in pooled analyses from five birth cohorts from low- and middle-income countries

Reynaldo Martorell, Bernardo L Horta, Linda S Adair, Aryeh D Stein, Linda Richter, Caroline H D Fall, Santosh K Bhargava, S K Dey Biswas, Lorna Perez, Fernando C Barros, Cesar G Victora, Consortium on Health Orientated Research in Transitional Societies Group, Reynaldo Martorell, Bernardo L Horta, Linda S Adair, Aryeh D Stein, Linda Richter, Caroline H D Fall, Santosh K Bhargava, S K Dey Biswas, Lorna Perez, Fernando C Barros, Cesar G Victora, Consortium on Health Orientated Research in Transitional Societies Group

Abstract

Schooling predicts better reproductive outcomes, better long-term health, and increased lifetime earnings. We used data from 5 cohorts (Brazil, Guatemala, India, the Philippines, and South Africa) to explore the relative importance of birthweight and postnatal weight gain for schooling in pooled analyses (n = 7945) that used appropriate statistical methods [conditional weight (CW) gain measures that are uncorrelated with prior weights] and controlled for confounding. One SD increase in birthweight, approximately 0.5 kg, was associated with 0.21 y more schooling and 8% decreased risk of grade failure. One SD increase in CW gain between 0 and 2 y, approximately 0.7 kg, was associated with higher estimates, 0.43 y more schooling, and 12% decreased risk of failure. One SD increase of CW gain between 2 and 4 y, approximately 0.9 kg, was associated with only 0.07 y more schooling but not with failure. Also, in children born in the lowest tertile of birthweight, 1 SD increase of CW between 0 and 2 y was associated with 0.52 y more schooling compared with 0.30 y in those in the upper tertile. Relationships with age at school entry were inconsistent. In conclusion, weight gain during the first 2 y of life had the strongest associations with schooling followed by birthweight; weight gain between 2 and 4 y had little relationship to schooling. Catch-up growth in smaller babies benefited schooling. Nutrition interventions aimed at women and children under 2 y are among the key strategies for achieving the millennium development goal of universal primary education by 2015.

References

    1. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS, for the Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371:340–57.
    1. Daniels MC, Adair LS. Growth in young Filipino children predicts schooling trajectories through high school. J Nutr. 2004;134:1439–46.
    1. Martorell R, Rivera J, Kaplowitz H, Pollitt E. Long-term consequences of growth retardation during early childhood. In: Hernández M, Argente J, editors. Human growth: basic and clinical aspects. Amsterdam: Elsevier Science Publishers B.V; 1992. p. 143–9.
    1. Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM. Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr. 2007;137:2464–9.
    1. Behrman JR, Rosenzweig MR. Returns to birthweight. Rev Econ Stat. 2004;86:586–601.
    1. Psacharopoulos G, Patrinos HA. Returns to investment in education: a further update. Educ Econ. 2004;12:111–34.
    1. Semba RD, de Pee S, Sun K, Sari M, Akhter N, Bloem MW. Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet. 2008;371:322–8.
    1. Bicego GT, Boerma JT. Maternal education and child survival: a comparative study of survey data from 17 countries. Soc Sci Med. 1993;36:1207–27.
    1. Huisman M, Kunst AE, Bopp M, Borgan J-K, Borrell C, Costa G, Deboosere P, Gadeyne S, Glickman M, et al. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet. 2005;365:493–500.
    1. Monteiro CA, Conde WL, Popkin BM. Independent effects of income and education on the risk of obesity in the Brazilian adult population. J Nutr. 2001;131:S881–6.
    1. United Nations Millennium Development Goals. [cited 2009 Apr 24]. Available from: .
    1. Richards M, Hardy R, Kuh D, Wadsworth EJ. Birthweight, postnatal growth and cognitive function in a national UK birth cohort. Int J Epidemiol. 2002;31:342–8.
    1. Cheung YB. Growth and cognitive function of Indonesian children: zero-inflated proportion models. Stat Med. 2006;25:3011–22.
    1. Li H, DiGirolamo AM, Barnhart HX, Stein AD, Martorell R. Relative importance of birth size and postnatal growth for women's educational achievement. Early Hum Dev. 2004;76:1–16.
    1. Emond AM, Blair PS, Emmett PM, Drewett RF. Weight faltering in infancy and IQ levels at 8 years in the Avon Longitudinal Study of Parents and Children. Pediatrics. 2007;120:1051–8.
    1. Cheung YB, Khoo KS, Karlberg J, Machin D. Association between psychological symptoms in adults and growth in early life: longitudinal follow up study. BMJ. 2002;325:749–751.
    1. Horta BL, Sibbritt DW, Lima RC, Victora CG. Weight catch-up and achieved schooling at 18 years of age in Brazilian males. Eur J Clin Nutr. 2009;63:369–74.
    1. Shrimpton R, Victora CG, de Onis M, Lima RC, Blössner M, Clugston G. Worldwide timing of growth faltering: Implications for nutritional interventions. Pediatrics. 2001;107:e75.
    1. Victora CG, Barros FC. Cohort profile: the 1982 Pelotas (Brazil) birth cohort study. Int J Epidemiol. 2006;35:237–42.
    1. Stein AD, Melgar P, Hoddinott J, Martorell R. Cohort profile: the Institute of Nutrition of Central America and Panama (INCAP) Nutrition Trial Cohort Study. Int J Epidemiol. 2008;37:716–20.
    1. Ghosh S, Bhargava SK, Moriyama IM. Longitudinal study of the survival and outcome of a birth cohort. New Delhi (India): Department of Pediatrics, Safdarjung Hospital; 1979.
    1. Bhargava SK, Sachdev HS, Fall CH, Osmond C, Lakshmy R, Barker DJP, Dey Biswas SK, Ramji S, Prabhakaran D. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med. 2004;350:865–75.
    1. Adair LS, Popkin BM. The Cebu Longitudinal Health and Nutrition Survey: history and major contributions of the project. Philipp Q Cult Soc. 2001;29:5–37.
    1. Richter L, Norris S, Pettifor J, Yach D, Cameron N. Cohort profile: Mandela's children: the 1990 Birth to Twenty study in South Africa. Int J Epidemiol. 2007;36:504–11.
    1. Ellison GTH, Richter LM, de Wet T, Harris HE, Griesel RD. The reliability of handwritten and computerized records of birth data collected at Baragwanath Hospital in Soweto. Curationis. 1997;20:36–40.
    1. WHO. Child growth standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76–85.
    1. Keijzer-Veen MG, Euser AM, van Montfoort N, Dekker FW, Vandenbroucke JP, Van Houwelingen HC. A regression model with unexplained residuals was preferred in the analysis of the fetal origins of adult diseases hypothesis. J Clin Epidemiol. 2005;58:1320–4.
    1. Li H, Stein AD, Barnhart HX, Ramakrishnan U, Martorell R. Associations between prenatal and postnatal growth and adult body size and composition. Am J Clin Nutr. 2003;77:1498–505.
    1. SAS Institute. Statistical software: release 9.1. Cary (NC): SAS Institute; 2002–2008.
    1. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr. 1999;129:1555–62.
    1. Berhman JR. The impact of health and nutrition on education. World Bank Res Obs. 1996;11:23–37.
    1. Alderman H, Hoddinott J, Kinsey B. Long term consequences of early childhood malnutrition. Oxf Econ Pap. 2006;58:450–74.
    1. Glewwe P, Jacoby HG, King EM. Early childhood nutrition and academic achievement: a longitudinal analysis. J Public Econ. 2001;81:345–68.
    1. Martorell R. Results and Implications of the INCAP Follow-up study. J Nutr. 1995;125:S1127–38.
    1. Maluccio JA, Hoddinott J, Behrman JR, Martorell R, Quisumbing AR, Stein AD. The impact of improving nutrition during early childhood on education among Guatemalan adults. Econ J. 2009;119:734–63.
    1. Stein AD, Wang M, DiGirolamo A, Grajeda R, Ramakrishnan U, Ramirez-Zea M, Yount K, Martorell R. Nutritional supplementation in early childhood, schooling, and intellectual functioning in adulthood: a prospective study in Guatemala. Arch Pediatr Adolesc Med. 2008;162:612–8.
    1. Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet. 2008;371:411–6.
    1. Adair L, Martorell R, Stein AD, Hallal PC, Harshpal SS, Prabhakaran D, Wills AK, Norris SA, Dahly DL. Size at birth, weight gain in infancy and childhood, and adult blood pressure in 5 low- and middle-income-country cohorts: when does weight gain matter? Am J Clin Nutr. 2009;89:1383–92.
    1. Sachdev HS, Fall CH, Osmond C, Lakshmy R, Dey Biswas SK, Leary SD, Reddy KS, Barker DJP, Bhargava SK. Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am J Clin Nutr. 2005;82:456–66.
    1. Newsome CA, Shiell AW, Fall CH, Phillips DI, Shier R, Law CM. Is birth weight related to later glucose and insulin metabolism? A systematic review. Diabet Med. 2003;20:339–48.
    1. Wells JC, Hallal PC, Wright A, Singhal A, Victora CG. Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years. Int J Obes (Lond). 2005;29:1192–98.
    1. Corvalán C, Gregory CO, Ramirez-Zea M, Martorell R, Stein AD. Size at birth, infant, early and later childhood growth and adult body composition: a prospective study in a stunted population. Int J Epidemiol. 2007;36:550–7.

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