The appropriate pattern of growth among infants that experience fetal growth restriction is not well understood. Data from developed countries suggest that rapid growth in childhood may place individuals at an elevated risk of later life chronic disease. However, there are substantial benefits to catch-up growth within the first two years of life in many malnourished settings. In some settings, early accelerated growth, however, is shown to have negative consequences on future risk of chronic diseases. Thus, the timing of catch up growth is of relevance, especially in populations experiencing nutrition transition, with concurrent undernutrition in infants and children and overnutrition among adults. The overall goal of the proposed secondary analysis is to determine the pattern of growth (linear and ponderal) from birth through infancy and childhood that is associated with overweight, adiposity, and early risk factors of cardiovascular disease and insulin resistance among adolescents and young adults (1714 years) in a rural South Asian population. We hypothesize that patterns of growth in infancy and childhood among those with a cardiometabolic risk will differ significantly from those without this risk in this rural Nepali population. In order to conduct this secondary analysis we will combine serial anthropometric measurements taken among 5,574 subjects during infancy and childhood during their participation in two vitamin A supplementation trials in the 1990's who were recently revisited and examined as adolescents and young adults. Overweight and high adiposity, high blood pressure, dyslipidemia, and insulin resistance were assessed in a follow-up study that we recently completed in 2006-2007 to examine long term effects of the nutrient interventions on growth, development, and cardometabolic risk. Data on a large number of socioeconomic, demographic, dietary, life style and health factors were collected, both at the time when the supplementation trial was carried out as well as at the time of the follow-up study. To address the specific aims of the proposed study, longitudinal anthropometric data will be used to characterize patterns of child growth trajectories from birth through adolescence/early adulthood that are associated with cardiometabolic risk using random effects models. The present analysis will be a significant contribution to the literature by better characterizing child growth and cardiometabolic risk in a region of the world where there is a high incidence of fetal growth restriction and growth faltering in childhood and a growing epidemic of cardiovascular disease and diabetes in adulthood.

Public Health Relevance

Project Narrative Slow growth in infancy followed by accelerated growth in later childhood has been associated with risk of cardiovascular disease and death in later life in high income settings. Our proposed secondary analyses, using longitudinal data from Nepal, will explore patterns of growth in early life that are associated with markers of cardiometabolic risk in adolescence/adulthood.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Research Grants (R03)
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Pediatrics Subcommittee (CHHD)
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Raiten, Daniel J
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Stewart, Christine P; Christian, Parul; Wu, Lee S F et al. (2013) Prevalence and risk factors of elevated blood pressure, overweight, and dyslipidemia in adolescent and young adults in rural Nepal. Metab Syndr Relat Disord 11:319-28
Khan, Rumana J; Stewart, Christine P; Christian, Parul et al. (2013) A cross-sectional study of the prevalence and risk factors for hypertension in rural Nepali women. BMC Public Health 13:55