Anthropometric indices for non-pregnant women of childbearing age differ widely among four low-middle income populations

K Michael Hambidge, Nancy F Krebs, Ana Garcés, Jamie E Westcott, Lester Figueroa, Shivaprasad S Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu, Adrien Lokangaka, Vanessa R Thorsten, Abhik Das, Kristen Stolka, Elizabeth M McClure, Rebecca L Lander, Carl L Bose, Richard J Derman, Robert L Goldenberg, Melissa Bauserman, K Michael Hambidge, Nancy F Krebs, Ana Garcés, Jamie E Westcott, Lester Figueroa, Shivaprasad S Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu, Adrien Lokangaka, Vanessa R Thorsten, Abhik Das, Kristen Stolka, Elizabeth M McClure, Rebecca L Lander, Carl L Bose, Richard J Derman, Robert L Goldenberg, Melissa Bauserman

Abstract

Background: Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).

Methods: Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m2) was calculated. Z-scores were determined using WHO reference data.

Results: A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = 1823); and Thatta, Sindh, Pakistan (n = 2009). Mean age was 23 y and mean parity 1.5. Median (P25-P75) height (cm) ranged from 145.5 (142.2-148.9) in Guatemala to 156.0 (152.0-160.0) in DRC. Median weight (kg) ranged from 44.7 (39.9-50.3) in India to 52.7 (46.9-59.8) in Guatemala. Median BMI ranged from 19.4 (17.6-21.9) in India to 24.9 (22.3-28.0) in Guatemala. Percent stunted (<-2SD height for age z-score) ranged from 13.9% in DRC to 80.5% in Guatemala; % underweight (BMI <18.5) ranged from 1.2% in Guatemala to 37.1% in India; % overweight/obese (OW, BMI ≥25.0) ranged from 5.7% in DRC to 49.3% in Guatemala. For all sites, indicators for higher SES and higher age were associated with BMI. Lower SES women were underweight more frequently and higher SES women were OW more frequently at all sites. Younger women tended to be underweight, while older women tended to be OW.

Conclusions: Anthropometric data for NPW varied widely among low-income rural populations in four countries located on three different continents. Global comparisons of anthropometric measurements across sites using standard reference data serve to highlight major differences among populations of low-income rural NPW and assist in evaluating the rationale for and the design of optimal intervention trials.

Trial registration: ClinicalTrials.gov # NCT01883193 (18 June 2013, retrospectively registered).

Keywords: Body mass index; Democratic Republic of the Congo; Guatemala; Height; India; Low middle income countries; Mid-upper arm circumference; Multi-site; Non-pregnant women; Overweight/obesity; Pakistan; Rural; Stunting; Underweight; Waist-hip ratio; Weight.

Figures

Fig. 1
Fig. 1
Women First trial: Prevalence of stunting and severe stunting in non-pregnant women of childbearing age by site. Stunted defined as -2SD height for age z-scores (HAZ). Severely stunted defined as -3SD HAZ [22]
Fig. 2
Fig. 2
Women First trial: Prevalence of underweight (UW) and overweight/obesity (OW) in non-pregnant women of childbearing age determined by Body Mass Index (BMI) by site. UW defined as BMI

Fig. 3

Women First trial: Correlation of…

Fig. 3

Women First trial: Correlation of mid-upper arm circumference (MUAC) with body mass index…

Fig. 3
Women First trial: Correlation of mid-upper arm circumference (MUAC) with body mass index (BMI) for non-pregnant women of childbearing age from four rural low- low-middle- income populations. The correlation between MUAC and BMI while controlling for site was 0.84; n = 7267
Fig. 3
Fig. 3
Women First trial: Correlation of mid-upper arm circumference (MUAC) with body mass index (BMI) for non-pregnant women of childbearing age from four rural low- low-middle- income populations. The correlation between MUAC and BMI while controlling for site was 0.84; n = 7267

References

    1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60. doi: 10.1016/S0140-6736(07)61690-0.
    1. Martorell R, Zongrone A. Intergenerational influences on child growth and undernutrition. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):302–314. doi: 10.1111/j.1365-3016.2012.01298.x.
    1. Ozaltin E, Hill K, Subramanian SV. Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries. JAMA. 2010;303(15):1507–1516. doi: 10.1001/jama.2010.450.
    1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51. doi: 10.1016/S0140-6736(13)60937-X.
    1. Subramanian SV, Ackerson LK, Davey Smith G, John NA. Association of maternal height with child mortality, anthropometric failure, and anemia in India. JAMA. 2009;301(16):1691–1701. doi: 10.1001/jama.2009.548.
    1. Kozuki N, Katz J, Lee AC, Vogel JP, Silveira MF, Sania A, et al. Short maternal stature increases risk of small-for-gestational-age and preterm births in low- and middle-income countries: individual participant data meta-analysis and population attributable fraction. J Nutr. 2015;145(11):2542–50. doi: 10.3945/jn.115.216374.
    1. Addo OY, Stein AD, Fall CH, Gigante DP, Guntupalli AM, Horta BL, et al. Maternal height and child growth patterns. J Peds. 2013;163(2):549–54. doi: 10.1016/j.jpeds.2013.02.002.
    1. Cesare MD, Bhatti Z, Soofi SB, Fortunato L, Ezzati M, Bhutta ZA. Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey. Lancet Glob Health. 2015;3(4):e229–e239. doi: 10.1016/S2214-109X(15)70001-X.
    1. National Institute of Statistics . In: National maternal and child health survey: 1998–1999. Ministry of Public Health and Social Assistance, editor. Guatemala City: National Institute of Statistics; 2003.
    1. Ministry of Health and Social Assistance . National maternal and child health survey: 2002. Guatemala City: National Institute of Statistics; 1999.
    1. Ministry of Public Health and Social Assistance . National maternal and child health survey: 2008–09. Guatemala City: Ministry of Public Health and Social Assistance/National Institute of Statistics/Centers for Disease Control and Prevention; 2010.
    1. International Institute for Population Sciences (IIPS) and Macro International . National Family Health Survey (NFHS-3), 2005–06. India: IIPS; 2007.
    1. Ministère du Plan et Suivi de la Mise en oeuvre de la Révolution de la Modernité, Ministère de la Santé Publique, International I . Enquête Démographique et de Santé (EDS-RDC): 2013–2014. Rockland: Ministère du Plan et Suivi de la Mise en oeuvre de la Révolution de la Modernité, Ministère de la Santé Publique, and ICF International; 2014.
    1. Ministerio de Salud Pública y Asistencia Social. MSPAS/Guatemala, Instituto Nacional de Estadística. INE/Guatemala, Secretaría de Planificación y Programación del la Presidencia. Segeplán/Guatemal, International . Encuesta Nacional de Salud Materno Infantil 2014–2015: Informe Final. Rockville: MSPAS, INE, Segeplán and ICF International; 2017.
    1. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67. doi: 10.1016/S0140-6736(10)62037-5.
    1. Kader M, Perera NK. Socio-economic and nutritional determinants of low birth weight in India. N Am J Med Sci. 2014;6(7):302–308. doi: 10.4103/1947-2714.136902.
    1. Corsi DJ, Mejia-Guevara I, Subramanian SV. Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions. Soc Sci Med. 2015;157:165–85. doi: 10.1016/j.socscimed.2015.11.014.
    1. Burke M, Heft-Neal S, Bendavid E. Sources of variation in under-5 mortality across sub-Saharan Africa: a spatial analysis. Lancet Glob Health. 2016;4(12):e936–e945. doi: 10.1016/S2214-109X(16)30212-1.
    1. Paciorek CJ, Stevens GA, Finucane MM, Ezzati M. Children’s height and weight in rural and urban populations in low-income and middle-income countries: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(5):e300–e309. doi: 10.1016/S2214-109X(13)70109-8.
    1. Hambidge KM, Krebs NF, Westcott JE, Garces A, Goudar SS, Kodkany BS, et al. Preconception maternal nutrition: a multi-site randomized controlled trial. BMC Pregnancy Childbirth. 2014;14:111. doi: 10.1186/1471-2393-14-111.
    1. Goudar SS, Carlo WA, McClure EM, Pasha O, Patel A, Esamai F, et al. The maternal and newborn health registry study of the global Network for Women’s and Children’s Health Research. Int J Gynaecol Obstet. 2012;118(3):190–3.
    1. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–667. doi: 10.2471/BLT.07.043497.
    1. Growth reference data for 5–19 years [].
    1. World Health Organization . Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva: World Health Organization; 2008.
    1. Deutsche Gesellschaft fur Sportmedizin und Pravention . Leitlinie Vorsorgeuntersuchung im Sport. 2007.
    1. Sustainable Development Goals: 17 Goals to Transform the World [].
    1. Alkire S, Santos ME. Acute Multidimensional Poverty: A New Index for Developing Countries. OPHI Working Papers. University of Oxford; 2010.
    1. Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc. 1927;22(158):209–212. doi: 10.1080/01621459.1927.10502953.
    1. Goudar SS, Stolka KB, Koso-Thomas M, Honnungar NV, Mastiholi SC, Ramadurg UY, et al. Data quality monitoring and performance metrics of a prospective, population-based observational study of maternal and newborn health in low resource settings. Reprod Health. 2015;12(Suppl 2):S2.
    1. Cheikh Ismail L, Knight HE, Bhutta Z, Chumlea WC. Anthropometric protocols for the construction of new international fetal and newborn growth standards: the INTERGROWTH-21st project. BJOG. 2013;120(Suppl 2):42–47, v. doi: 10.1111/1471-0528.12125.
    1. Hruschka DJ, Hadley C, Brewis A. Disentangling basal and accumulated body mass for cross-population comparisons. Am J Phys Anthropol. 2014;153(4):542–550. doi: 10.1002/ajpa.22452.
    1. Hruschka DJ, Brewis AA. Absolute wealth and world region strongly predict overweight among women (ages 18-49) in 360 populations across 36 developing countries. Econ Hum Biol. 2013;11(3):337–344. doi: 10.1016/j.ehb.2012.01.001.
    1. Hruschka DJ, Hadley C. How much do universal anthropometric standards bias the global monitoring of obesity and undernutrition? Obesity Rev. 2016;17(11):1030–1039. doi: 10.1111/obr.12449.
    1. Fan S, Hansen ME, Lo Y, Tishkoff SA. Going global by adapting local: a review of recent human adaptation. Science. 2016;354(6308):54–59. doi: 10.1126/science.aaf5098.
    1. Vangeel EB, Izzi B, Hompes T, Vansteelandt K, Lambrechts D, Freson K, et al. DNA methylation in imprinted genes IGF2 and GNASXL is associated with prenatal maternal stress. Genes Brain Behav. 2015;14(8):573–82. doi: 10.1111/gbb.12249.
    1. Enquobahrie DA, Wander PL, Tadesse MG, Qiu C, Holzman C, Williams MA. Maternal pre-pregnancy body mass index and circulating microRNAs in pregnancy. Obes Res Clin Pract. 2016;(16):30399–4. (Epub ahead of print).
    1. Desai P, Hazra M, Trivedi LB. Pregnancy outcome in short statured women. J Indian Med Assoc. 1989;87(2):32–34.
    1. Sheiner E, Levy A, Katz M, Mazor M. Short stature--an independent risk factor for Cesarean delivery. Eur J Obstet Gynecol Reprod Biol. 2005;120(2):175–178. doi: 10.1016/j.ejogrb.2004.09.013.
    1. Chan BC, Lao TT. The impact of maternal height on intrapartum operative delivery: a reappraisal. J Obstet Gynaecol Res. 2009;35(2):307–314. doi: 10.1111/j.1447-0756.2008.00939.x.
    1. World Health Organization Maternal anthropometry and pregnancy outcomes: a WHO collaborative study. Bull World Health Organ. 1995;73(suppl):S1–98.
    1. Adair LS, Fall CH, Osmond C, Stein AD, Martorell R, Ramirez-Zea M, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013;382(9891):525–34. doi: 10.1016/S0140-6736(13)60103-8.
    1. Addo OY, Stein AD, Fall CH, Gigante DP, Guntupalli AM, Horta BL, et al. Parental childhood growth and offspring birthweight: pooled analyses from four birth cohorts in low and middle income countries. Am J Hum Biol. 2015;27(1):99–105. doi: 10.1002/ajhb.22614.
    1. Victora CG, Barros FC. Cohort profile: the 1982 Pelotas (Brazil) birth cohort study. Int J Epidemiol. 2006;35(2):237–242. doi: 10.1093/ije/dyi290.
    1. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57. doi: 10.1016/S0140-6736(07)61692-4.
    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(4):716–20. doi: 10.1093/ije/dyn028.
    1. Sachdev HS, Fall CH, Osmond C, Lakshmy R, Dey Biswas SK, Leary SD, et al. 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(2):456–66.
    1. Adair LS, Popkin BM, Akin JS, Guilkey DK, Gultiano S, Borja J, et al. Cohort profile: the Cebu longitudinal health and nutrition survey. Int J Epidemiol. 2011;40(3):619–25. doi: 10.1093/ije/dyq085.
    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(3):504–511. doi: 10.1093/ije/dym016.
    1. Ministry of Public Health and Social Assistance . National Maternal and child health survey: 2015. Guatemala City: Ministry of Public Health and Social Assistance/National Institute of Statistics/Centers for Disease Control and Prevention; 2016.
    1. Berngard SC, Berngard JB, Krebs NF, Garces A, Miller LV, Westcott J, et al. Newborn length predicts early infant linear growth retardation and disproportionately high weight gain in a low-income population. Early Hum Dev. 2013;89(12):967–72. doi: 10.1016/j.earlhumdev.2013.09.008.
    1. Solomons NW, Vossenaar M, Chomat AM, Doak CM, Koski KG, Scott ME. Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala. Public Health Nutr. 2015;18(10):1737–1745. doi: 10.1017/S136898001400264X.
    1. Ramirez-Zea M, Kroker-Lobos MF, Close-Fernandez R, Kanter R. The double burden of malnutrition in indigenous and nonindigenous Guatemalan populations. Am J Clin Nutr. 2014;100(6):1644S–1651S. doi: 10.3945/ajcn.114.083857.
    1. Aga Khan University, Nutrition Wing Cabinet Division Government of Pakistan, Pakistan Medical Research Council, UNICEF Pakistan. National Nutrition Survey: Pakistan. Karachi: Aga Khan University, Nutrition Wing Cabinet Division Government of Pakistan, Pakistan Medical Research Council, UNicEF Pakistan; 2011.
    1. Krebs NF, Mazariegos M, Chomba E, Sami N, Pasha O, Tshefu A, et al. Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings. Am J Clin Nutr. 2012;96(4):840–7. doi: 10.3945/ajcn.112.041962.
    1. United Nations Children’s Fund (UNICEF) The state of the World’s Chidren: maternal and newborn health. New York: UNICEF; 2008.
    1. Krebs NF, Mazariegos M, Tshefu A, Bose C, Sami N, Chomba E, et al. Meat consumption is associated with less stunting among toddlers in four diverse low-income settings. Food Nutr Bull. 2011;32(3):185–91. doi: 10.1177/156482651103200301.
    1. Hoddinott J, Behrman JR, Maluccio JA, Melgar P, Quisumbing AR, Ramirez-Zea M, et al. Adult consequences of growth failure in early childhood. Am J Clin Nutr. 2013;98(5):1170–8. doi: 10.3945/ajcn.113.064584.
    1. Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ, et al. Critical windows for nutritional interventions against stunting. Am J Clin Nutr. 2013;97(5):911–8. doi: 10.3945/ajcn.112.052332.
    1. NCD Risk Factor Collaboration Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377–1396. doi: 10.1016/S0140-6736(16)30054-X.
    1. Torloni MR, Betran AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obesity Rev. 2009;10(2):194–203. doi: 10.1111/j.1467-789X.2008.00541.x.
    1. Sohlberg S, Stephansson O, Cnattingius S, Wikstrom AK. Maternal body mass index, height, and risks of preeclampsia. Am J Hypertens. 2012;25(1):120–125. doi: 10.1038/ajh.2011.175.
    1. Lampl M. Patterns of normal fetal and postnatal growth during the 1st 1000 days, ASN Scientific Sessions at Experimental Biology 2016. San Diego: FASEB; 2016.
    1. Dempsey JC, Ashiny Z, Qiu CF, Miller RS, Sorensen TK, Williams MA. Maternal pre-pregnancy overweight status and obesity as risk factors for cesarean delivery. J Matern Fetal Neona. 2005;17(3):179–185. doi: 10.1080/14767050500073456.

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