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Anthropometric proxies for child neurodevelopment in low-resource settings: length- or height-for-age, head circumference or both?

Published online by Cambridge University Press:  18 July 2022

Molly M. Lamb Open the ORCID record for Molly M. Lamb [Opens in a new window] ,
Amy K. Connery Open the ORCID record for Amy K. Connery [Opens in a new window] ,
Alison M. Colbert ,
Desirée Bauer ,
Daniel Olson ,
Alejandra Paniagua-Avila ,
Diva M. Calvimontes ,
Guillermo Antonio Bolaños ,
Hana M. El Sahly  and
Flor M. Muñoz
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Molly M. Lamb*
Affiliation:
Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
Amy K. Connery
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
Alison M. Colbert
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
Desirée Bauer
Affiliation:
Center for Human Development, Fundación Para LA Salud Integral DE los Guatemaltecos, Retalhuleu, Guatemala
Daniel Olson
Affiliation:
Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA Children’s Hospital Colorado, Aurora, CO, USA Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Alejandra Paniagua-Avila
Affiliation:
Center for Human Development, Fundación Para LA Salud Integral DE los Guatemaltecos, Retalhuleu, Guatemala Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
Diva M. Calvimontes
Affiliation:
Center for Human Development, Fundación Para LA Salud Integral DE los Guatemaltecos, Retalhuleu, Guatemala
Guillermo Antonio Bolaños
Affiliation:
Center for Human Development, Fundación Para LA Salud Integral DE los Guatemaltecos, Retalhuleu, Guatemala
Hana M. El Sahly
Affiliation:
Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
Flor M. Muñoz
Affiliation:
Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Edwin J. Asturias
Affiliation:
Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA Children’s Hospital Colorado, Aurora, CO, USA Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
*
Address for correspondence: Molly M. Lamb, Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. Email: molly.lamb@cuanschutz.edu
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Abstract

Stunting (<−2 SD of length- or height-for-age on WHO growth curves) is the most used predictor of child neurodevelopmental (ND) risk. Occipitofrontal head circumference (OFC) may be an equally feasible, but more direct and robust predictor. We explored association of the two measurements with ND outcome, separately and combined, and examined if cutoffs are more efficacious than continuous measures in predicting ND risk. Infants and young children in rural Guatemala (n = 642; age range = 0.1–35.9 months) were enrolled in a prospective natural history study, and their ND was tested using the Mullen Scales of Early Learning (MSEL) longitudinally. Length- or height-for-age and OFC-for-age were calculated. We performed age-adjusted multivariable regression analyses to explore the association between 1) length or height and ND, 2) OFC and ND, and 3) both length or height and OFC combined, with ND; concurrently, predictively, and longitudinally, as continuous variables and using WHO z-score cutoffs. Continuous length- or height-for-age and OFC z-scores were more strongly associated with MSEL than the traditional -2 SD WHO cutoff. The combination of height-for-age z-score and OFC z-score was consistently, strongly associated with the MSEL Early Learning Composite concurrently (p-values 0.0004–0.11), predictively (p-value 0.001–0.07), with the exception of the 18–24 months age group which had very few records, and in the longitudinal model (p-value <0.0001–0.004). The combination of continuous length- or height-for-age and OFC shows additional utility in estimating ND risk in infants and young children. Measurement of OFC may improve precision of prediction of ND risk in infants and young children.

Keywords

Head circumferencestuntingneurodevelopmentyoung childrenlow-resource settings
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 14 , Issue 1 , February 2023 , pp. 61 - 69
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Copyright
© The Author(s), 2022. Published by Cambridge University Press in association with International Society for Developmental Origins of Health and Disease

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Footnotes

*

Molly M. Lamb and Amy K. Connery are co-first authors.

**

Flor M. Muñoz and Edwin J. Asturias are co-senior authors.

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