Abnormal weight gain in infant

as the risk of stunting in later life

Rina Pratiwi
Divisi Nutrisi dan Penyakit Metabolik
Bag Ilmu Kesehatan Anak
FK UNDIP-RSDK
 Weight gain in infancy has long been
recognized as an important
determinant of subsequent growth
trajectory

Anthropometric measurements are

INTRODUCTION significant indices to predict infant
health and future outcome

Growth velocity is a desireable

approach that depicts the age-
dependent changes in velocity that
characterize human postnatal growth
 Levels and
Stunting affected an estimated
21.9 per cent or 149 million
children under 5 globally in 2018.

149 million

trends in child
malnutrition
UNICEF / WHO / World Bank Group
Joint Child Malnutrition Estimates

Globally à Stunting
Key findings of the 2019 edition

These new estimates supersede former

analyses and results published by UNICEF,
WHO and the World Bank Group.

affected estimated
In 2018, wasting continued to
= 1 million
29.1 % or 149 million
children under 5
threaten the lives of an estimated
7.3 per cent or 49 million children children under 5
under 5 globally.

49 million

An estimated 5.9 per cent or

40 million children under 5
around the world were
overweight in 2018.

40 million
Timing of
weight
faltering
Timing of
growth
faltering
• Mean weight start to falter at about 3 months of age and decline
rapidly until about 12 months, with a markedly slower decline until
about 18 to 19 months and a catch-up pattern after that
• For length/height for age, faltering starts immediately afterward,
lasting well into the third year.
• Linear growth in early childhood à strong marker of healthy growth given its
association with morbidity and mortality risk, non-communicable diseases in later
life and learning capacity and productivity
• Average LAZ among newborns in developing countries is approximately -0.5 and
continues -2.0 by 18-24 months of age (Victora et al, 2010)
• Increase in birthweight and linear growth velocity between conception and 2
years of age in children in developing countries is likely to reduce morbidity and
mortality and provide substantial increases in human capital (Pandergrast 2014)
• Growth failure in the first 2 years of life is associated with reduce stature in
adulthood (Coly et al 2016; Stein et al 2010)
Linear growth faltering in children, Inadequate weight in a
characterized by falling below the malnourished child is associated
height-for-age trajectory of the with slowed recovery in linear
WHO-CGS (de Onis& Branca 2016) growth

Isanaka et al.MCN 2019

1991 : UNICEF à strategy for promotion of child health “GOBI” à community-based growth
monitoring

G à growth monitoring monthly à early detection of growth failure

The aim àto weigh children and plot the weight on a growth chart to detect growth faltering early,
allowing community workers to advise mothers on how to improve the growth of faltering child

Weight gain between 3 and 6 month of age predicted stunting just as well as weight at age 1 year
did
• Interest has been increasing in designing and evaluating programs
and interventions that aim to increase parental efforts to support
child health and nutrition
• HBGM had modest positive effect on children with stunted growth
• A cost-effective tool for increasing parental efforts toward reducing
children’s physical growth deficits

Am J Clin Nutr 2017

• Weight faltering in early infancy
was associated with poorer
educational outcomes in later
childhood
• This finding particularly in
developing country where
nutritional inadequacy is common

BMJ 2013
• Positive pooled effects on both LAZ or HAZ
and development scores were found in
nutrition studies that were done in low and
middle-income countries
• In studies that provided macronutrients and
micronutrients
• The common nutritional determinant of
faltering in both linear growth and
development in low and middle income
countries à postnatal inadequate dietary
intake of macro and micronutrients during
early childhood

Lancet 2019
Interpret trends on growth chart

“normally” growing children follow trends, in general, parallel to

the median and z-score lines

Most children will grow in a “track” à on or between z-score lines

and roughly parallel to the median, may below or above median

A child’s growth line crosses a z-score line

Be alert for the following There is a sharp incline or decline in the child’s
situations : growth line
Child’s growth line remains flat (stagnant)
Growth velocity à the rate of change in physical size over a specified time interval

Pattern of growth velocity as an early signal of healthy or unhealthy responses to

environmental conditions

Length and weight velocities in month 1 of life were significant positives

determinants of attained growth by age 12 months

Higher levels of weight gain fluctuations for individual children throughout infancy
enabled greater attained length

MCN 2012
• Children who were malnourished at age 2 years had lower mean
growth z scores at birth and throughout the study period
• Anthropometric indicators in infancy were significant predictors for
growth at the age of 2 years during most periods and at most ages in
infancy.
• WAZ, LAZ and WLZ score at 12 months old à predict the same
indicator at age 24 months
• Growth measures at one time point in infancy was better correlated
with undernutrition at age 2 years than growth velocity

J Pediatr 2007
• History of FTT was associated with :
• Short stature
• Poor math performance
• Poor work habits
 Height
velocity 2-18
years

Tanner and davies

AAFP,2008
Nelson 19th
 What next?

Am Fam Physician 2008

General
screening test for
evaluation of
abnormal growth

Am Fam Physician 2008

Red flag

Am Fam Physician 2011

 • growth monitoring is crucial in early life
especially birth to 8 weeks
• The identification of faltering growth
TAKE HOME depends on a number of different
observations, including change in weight and
MESSAGE length overtime
• To be effective, growth monitoring must be
accompanied by community based health
and nutrition interventions