Developmental origins of health and disease: a new approach for the identification of adults who suffered undernutrition in early life

Abstract

Background

Undernutrition in early life (UELife) is a condition associated with greater occurrence of chronic diseases in adulthood. Some studies on this relationship have used short stature as indicator of UELife. However, other non-nutritional factors can also determine short stature. Depending on the severity of UELife, the human body reacts primarily compromising weight and length gain, but prioritizing brain growth, resulting in disproportionate individuals. Based on this premise, this study aimed to validate a new anthropometric indicator of UELife.

Design

Using stature and head circumference data from a probabilistic sample of 3,109 women, the Head-to-Height Index was calculated: HHI = (head × 2.898)/height. A HHI >1.028 (75th percentile) was the best cutoff for predicting obesity (best balance between sensitivity/ specificity, largest area under the receiver operating characteristic curve, and highest correlation coefficient) and was used to define the condition of body disproportionality. The strength of associations with several outcomes was tested for both disproportionality and short stature (height ≤25th percentile: 153.1 cm).

Results

In adjusted analysis for confounding factors (age, smoking, and education level), the strength of the associations between body disproportionality and the analyzed outcomes was greater than that observed when short stature was used. Respectively, the observed prevalence ratios (95% CI) were (P<0.05 for all comparisons): obesity: 2.61 (2.17–3.15) vs 1.09 (0.92–1.28); abdominal obesity: 2.11 (1.86–2.40) vs 1.42 (1.27– 1.59); high blood pressure: 1.24 (1.02–1.50) vs 0.90 (0.75–1.08); hypercholesterolemia: 2.98 (1.47–6.05) vs 1.65 (0.91–2.99); and hypertriglyceridemia: 1.47 (1.07–2.03) vs 0.91 (0.69–1.21).

Conclusion

Body disproportionality is a more accurate indicator of UELife than short stature. While short stature may be genetically determined, a high HHI is due to metabolic adaptations to undernutrition in early life.

Keywords:

• anthropometric indices
• metabolic risk factors
• cardiovascular risk
• obesity
• dyslipidemia
• epidemiological survey

Acknowledgments

This work is part of the II Diagnosis of Maternal and Child Health of the Population of Alagoas State, carried out with funds from Brazilian National Council for Scientific and Technological Development – CNPq (grant number 474381/2011-0), and Foundation of Research Support of Alagoas State – FAPEAL (grant number 20110818-006-0018-0017). HSF is a research fellow of the CNPq (grant number 302732/2015-2).

Disclosure

The authors report no conflicts of interest in this work.