Correlates of Body Composition in Children with Stunting: A Cross-sectional Study in Uganda

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Background: Development of body composition (BC) may be disrupted in children with stunting. Such disruption may affect the later risk of excess adiposity and metabolic health, yet few studies have investigated correlates of BC in children with stunting. Objectives: We aimed to investigate nutritional status, infection and inflammation, breastfeeding behaviors, and other factors as correlates of BC in children with stunting. Methods: Among Ugandan children with a height-for-age z-score <−2, BC was estimated using bioelectrical impedance analysis and compared with United Kingdom references. We used multiple linear regression analysis to identify correlates of fat mass (FM), fat-free mass (FFM), FM-index (FMI), and FFM index (FFMI) and height, adjusting for gender and age. Results: In 750 children aged 1–5 y, FMI was 0.46 (95% confidence interval [CI]: 0.38, 0.54] and FFMI 0.18 [95% CI: 0.11, 0.26) z-scores lower than United Kingdom references. Elevated serum α1-acid glycoprotein was associated with 1.14 [0.76, 1.52] cm lower height, 0.50 [0.35, 0.65] kg/m2 less FFMI, and 0.48 [0.31, 0.66] kg/m2 greater FMI. Similar, weaker, associations for elevated serum C-reactive protein were detected. A positive malaria rapid test was associated with 0.64 [0.25, 1.02] cm shorter height, but 0.36 [0.18, 0.54] kg/m2 greater FMI. Anemia (according to hemoglobin) was associated with 0.20 [0.07, 0.33] kg less FFM in proportion to shorter height. Longer breastfeeding duration was associated with 0.03 [0.02, 0.04] kg greater FFM per month, in proportion to greater height. Conclusions: These children exhibited deficits in FM and FFM, proportionally to their stunted height, compared with United Kingdom references. Systemic inflammation correlated inversely with linear growth and FFM but positively with fatness, making it a possible target for intervention where fat-free tissue accretion is desirable. Longer breastfeeding may offer protection to lean linear growth, but findings for micronutrients were less clear. Longitudinal studies are warranted to support these findings. The study was registered at www.isrctn.com (Ref. ISRCTN13093195).

OriginalsprogEngelsk
TidsskriftJournal of Nutrition
ISSN0022-3166
DOI
StatusAccepteret/In press - 2024

Bibliografisk note

Funding Information:
HAZ correlated with both FM and FFM, indicating that better growth leads to improved metabolic capacity and greater energy reserves. Both tissue losses were proportional to reduced height according to the absence of correlation with FFMI and FMI. This may reflect an equivalent protection of valuable organ mass as well as adipose, which performs important immune functions [33,36]. These tissues are likely prioritized above long-bone development. In Peruvian children, tibia and ulna lengths were more readily sacrificed in the face of nutritional and environmental stress [33]. Height remained part of the estimation in the form of impedance index (height2/Z). For this reason, we wanted to test the associations of HAZ with alternative markers of FFMI and FMI, which resulted in positive and negative associations, respectively. These proxies have been used effectively in an Ethiopian study [37], and although they are not validated in stunted children, may indicate some uncertainty in our HAZ correlates. This uncertainty is not shared by isotope dilution studies [17,18]. Deuterium-derived BC estimates from a similar sample of children supported an absence of HAZ associations with FFMI and FMI fromBIA, but the sample also exhibited no association with theBIA proxies. These findings highlight the need for careful consideration of BC methodology when investigating growth as a predictor of tissue compartments.This research was funded by Arla Food for Health, https://arlafoodforhealth.com. Arla Food for Health is a public\u2013private research partnership between the University of Copenhagen, Aarhus University and the dairy company, Arla. Additional funds were obtained from the Danish Dairy Research Foundation https://danishdairyboard.dk/research/ddrf, Augustinus Fonden https://augustinusfonden.dk, L\u00E6ge Sofus Carl Emil Friis og Hustru Olga Doris Friis\u2019 Legat, and A. P. M\u00F8ller Fonden til L\u00E6gevidenskabens Fremme, https://www.apmollerfonde.dk/ansoegning/fonden-til-laegevidenskabensfremme. The funding sources were not involved in study design, collection, analysis, interpretation, or decision to publish.

Funding Information:
This research was funded by Arla Food for Health, https://arlafoodforhealth.com . Arla Food for Health is a public\u2013private research partnership between the University of Copenhagen, Aarhus University and the dairy company, Arla. Additional funds were obtained from the Danish Dairy Research Foundation https://danishdairyboard.dk/research/ddrf , Augustinus Fonden https://augustinusfonden.dk , L\u00E6ge Sofus Carl Emil Friis og Hustru Olga Doris Friis\u2019 Legat, and A. P. M\u00F8ller Fonden til L\u00E6gevidenskabens Fremme, https://www.apmollerfonde.dk/ansoegning/fonden-til-laegevidenskabensfremme . The funding sources were not involved in study design, collection, analysis, interpretation, or decision to publish.

Publisher Copyright:
© 2024 American Society for Nutrition

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