Effects of stunting in infancy on body composition in late adolescence in a Peruvian cohort

Linear growth retardation is common in developing countries and disproportionately affects the poor. The long-term effects of early childhood malnutrition on later body composition are still unclear given the limited number of studies assessing adult outcomes. We revisited participants of a 1989 birth cohort that obtained monthly anthropometric measurements and daily diarrheal surveillance records during the first two years of life. Of 239 children in the original cohort, 145 (61%) had an additional anthropometric assessment in 1999, and 124 (52%) had a third assessment in 2008. At the 2008 follow-up, the cohort had a mean age of 18.6 years (SD=0.4), mean height of 160.5 cm (SD=8.9) and mean body mass index (BMI) of 22.9 (SD = 3.6). After adjusting for age, sex, and maternal education, stunting during the first and second years of life were associated with deficits in stature of 5.0 cm (p<0.001) and 5.6 cm (p<0.001), respectively. In multivariable analysis, stunting in the first year of life was associated with a reductions in lean mass index of -0.9 kg/m2 (p=0.023) and BMI of 1.8 kg/m2 (p=0.034). Late adolescent height was strongly associated with stunting in infancy, indicating growth lost during this critical time period may be unrecoverable. While some weight-related indices were negatively associated with stunting in infancy, the effects of malnutrition and stunting on fat distribution and total body composition were less clear. Intervention efforts focusing on preventing undernutrition in infancy may offer significant improvements to quality of life for at risk populations.