The effect of childhood stunting and wasting on adolescent cardiovascular diseases risk and educational achievement in rural Uganda: a retrospective cohort study

ABSTRACT

Background: Little is known about the long-term effects of early childhood undernutrition on adolescent cardiovascular disease risk and educational performance in low-income countries. We examined this in a rural Ugandan population.

Objective: To investigate if stunting or wasting among children aged 2–5 years is associated with cardiovascular disease risk or educational achievement during adolescence.

Methods: We conducted analyses using data from a cohort of children followed from early childhood to adolescence. Weight and height were measured in 1999–2000 when the children were 2–5 years of age and repeated in 2004/2005 and 2011. We compared cardiovascular disease risk parameters (mean blood pressure, lipids, HbA1c) and schooling years achieved in 2011 among 1054 adolescents categorised into four groups: those who experienced stunting or wasting throughout follow-up; those who recovered from stunting or wasting; those who were normal but later became stunted or wasted; and those who never experienced stunting or wasting from childhood up to adolescence. We controlled for possible confounding using multiple generalised linear regression models along with Generalised Estimating Equations to account for clustering of children within households.

Results: Wasting was negatively associated with systolic blood pressure (−7.90 95%CI [−14.52,-1.28], p = 0.02) and diastolic blood pressure (−3.92, 95%CI [−7.42, −0.38], p = 0.03). Stunting had borderline negative association with systolic blood pressure (−2.90, 95%CI [−6.41, 0.61] p = 0.10). Recovery from wasting was positively associated with diastolic blood pressure (1.93, 95%CI [0.11, 3.74] p = 0.04). Stunting or wasting was associated with fewer schooling years.

Conclusion: Recovery from wasting rather than just an episode in early childhood is associated with a rise in blood pressure while educational achievement is compromised regardless of whether recovery from undernutrition happens. These findings are relevant to children exposed to undernutrition in low-income settings.

KEYWORDS:

• Child hood undernutrition
• blood pressure
• schooling
• adolescence
• Uganda

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

We thank the study participants, community leaders and the GPC study team for their tremendous contributions to this work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

The study was approved by Uganda Virus Research Institute Research Ethics Committee and the Uganda National Council for Science and Technology (Reference HS640). Informed consent was obtained from parents or guardians for children under 7 years of age. Children aged 8-17 years provided assent in conjunction with parental/guardian consent. Adolescents older than 18 years consented to their own procedures.

Paper context

Little is known about the relationship between early undernutrition and health effects on later life in low- and middle-income countries where the burden of undernutrition is high. We investigated this in a rural Ugandan population and found that recovery from wasting is associated with a rise in blood pressure while both wasting and stunting regardless of recovery were associated with low educational achievement. Interventions preventing undernutrition are needed to address additional long-term effects.

Additional information

Funding

This work was supported by Medical Research Council (MRC), UK [grant numbers G0801566 and G090121392157] awarded to MRC/UVRI Uganda Research Unit on AIDS and we gratefully acknowledge this funding.

Notes on contributors

Gershim Asiki

Gershim Asiki coordinated the study, participated in data management, conducted data analysis, drafted the manuscript and revised after comments. Robert Newton and Lars Smedman reviewed the analysis. Robert Newton and Anatoli Kamali directed the work. All authors reviewed the manuscript and provided comments.