Growth retardation starts in the first three months of life among rural Guatemalan children

Abstract

Objective: We tested the hypothesis that growth faltering in rural Guatemala starts earlier than between 3–6 months of life, as generally assumed.

Methods: The sample included children from the INCAP longitudinal trial (1969–1977), who had adequate birth weight (>−1 s.d.) (n=79). Two groups were formed according to weight-for-age (WAZ) at 3 y: Group A: WAZ<−2 s.d. (growth-retarded), and Group B: WAZ ≥−2 s.d. Weight increments were computed and sex- and gender-specific deficits in weight increments from 0–36 months were calculated by comparing values of the WHO/CDC reference data. For the period between 0–12 months, weight increments were also compared to velocity standards: (1) the Fels data and (2) the WHO growth curves for breast fed infants.

Results: At 3 y of age, growth-retarded children were 3.6 kg smaller than the WHO/CDC median. Depending on the reference data used, between 19 and 34% of the deficit at 3 y of age was due to failure to thrive during the first 3 months of life, an additional 12–19% occurred between 3 and 6 months and 12–25% between 6 and 9 months. By 12 months of age, infants had accumulated 45–80% of their total deficit in weight at 3 y of age. Compared to group B, children from group A had greater morbidity during their first 9 months of life, and their mothers had poorer nutritional status at 3 months postpartum. There were indications that children from group A came from more deprived families.

Conclusions: Growth faltering starts soon after birth in rural Guatemala and thus, effective interventions should be targeted to mothers and their infant as early as possible during the first year.

Sponsorship: Support for data analysis was provided by NIH (grant # HD22440) and by the Pew Charitable Trusts (grant # 92-027216-000).