Associations between stunting and high-ponderosity defined through weight-for-height or body-mass-index for -age in under-five children

High-ponderosity :weight-for-height vs body-mass-index for age

Abstract

Background: Association between overweight and stunting has been inconsistently documented.  In under-five children, high-ponderosity is definedas >1SD and >2SD of WHO standards for either weight-for-heightor body-mass-index-for-agemetrics, and labelled as possible risk of overweight and overweight, respectively. Unlike body-mass-index-for-age (BMI-for-age),weight-for-height ignores physiological changes in ponderosity with age, resulting in underestimation of overweight defined through weight-for-height in comparison to BMI-for-age in populations with high stunting prevalence.This suggests that overweight-stunting associations could vary with the metric used to ascertain high ponderosity.

Aim:To test the null hypothesis that concurrent possible risk of overweight-stunting defined through weight-for-height and BMI-for-age (CSPO_WHZ and CSPO_BMIZ) associations are similar.

Methods:Demographic Health Survey datasets after 2010 from South-and South-East Asia and Sub-Saharan Africa were evaluated.CSPO_WHZand CSPO_BMIZ associations were estimated as odds ratio (OR)for individual datasets, which were pooled (random-effects meta-analysis).Stratified analyses were done for age and region.

Results: Young-infants (0-6 months) comprised 8%-14% of under-five children, with almost equal representation of boys and girls.  Participants, especially Asians, were mostly shorter with lower ponderosity than WHO standards.CSPO_WHZprevalence was lower than CSPO_BMIZin 6-59 months, but higher in young infants.Pooled CSPO_WHZestimates were not significant: Asia (OR 1.02; 95% CI 0.49-1.54),Africa (1.02; 0.88-1.17), and combined (1.02; 0.81-1.24).In contrast, pooledCSPO_BMIZ associations were significantly positive for, Africa (1.55; 1.36-1.74), and combined (1.55; 1.30-1.81), but not for Asia (1.54; 0.92-2.16).

Conclusion:CSPO_WHZand CSPO_BMIZassociations are dissimilar, possibly because the weight-for-height metric ignores changes in ponderosity with age.