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

Figures & data

Table 1. Characteristics of Adolescents in rural Uganda stratified by nutritional status during childhood.

		Change in height-for-age									Change in weight-for-height
		None				Changed					None				Changed
		Normal		Stunted		Recovered^1		Deteriorated^1			Normal		Wasted		Recovered^2		Deteriorated^2
Characteristic		n	%	n	%	n	%	n	%		n	%	n	%	n	%	n	%
Total		261	28.3	93	10.1	295	31.5	275	29.8		464	50.0	12	1.3	145	15.6	307	33.1
Age at adolescence
	13–15	137	52.5	60	64.5	147	49.8	165	60.0		247	53.2	9	75.0	70	48.3	183	59.6
	16–17	61	23.4	15	16.1	88	29.8	70	25.5		118	25.4	3	25.0	39	26.9	72	23.5
	18–19	63	24.1	18	19.4	60	20.3	40	14.6		99	21.3	0	0.0	36	24.8	52	16.9
Sex
	Male	108	41.4	63	67.7	128	43.4	151	54.9		215	46.3	7	58.3	65	44.8	166	54.1
	Female	153	58.6	30	32.3	167	56.6	124	45.1		249	53.7	5	41.7	80	55.2	141	45.9
Tribe
	Muganda	179	68.6	74	79.6	224	75.9	203	73.8		348	75.0	9	75.0	98	67.6	234	76.2
	Other	82	31.4	19	20.4	71	24.1	72	26.2		116	25.0	3	25.0	47	32.4	73	23.8
Education level attained
	Incomplete primary	115	47.5	70	75.3	133	46.7	153	57.5		219	49.9	9	75.0	69	49.6	174	58.4
	Completed primary	53	21.9	8	8.6	56	19.7	49	18.4		84	19.1	1	8.3	29	20.9	47	15.8
	Post-primary	74	30.6	15	16.1	96	33.7	64	24.1		136	31.0	2	16.7	41	29.5	77	25.8
Religion
	Roman catholic	150	60.0	60	65.9	168	59.4	170	64.4		281	62.9	9	75.0	86	61.0	176	59.7
	Muslim	68	27.2	24	26.4	75	26.5	66	25.0		118	26.4	2	16.7	31	22.0	84	28.5
	Other Christian	32	12.8	7	7.7	40	14.1	28	10.6		48	10.7	1	8.3	24	17.0	35	11.9
Wall construction material
	Mud and pole	32	17.3	17	25.0	44	21.9	36	19.3		66	20.1	1	12.5	20	19.4	44	21.1
	Mud and brick	90	48.7	23	33.8	82	40.8	84	44.9		153	46.7	5	62.5	42	40.8	87	41.6
	Concrete and brick	63	34.1	28	41.2	75	37.3	67	35.8		109	33.2	2	25.0	41	39.8	78	37.3
Roof quality
	Poor	28	15.1	12	17.7	32	15.8	24	12.8		56	17.0	4	50.0	15	14.4	27	12.9
	Fair	80	43.0	22	32.4	63	31.2	66	35.3		115	35.0	4	50.0	37	35.6	86	41.2
	Good	78	41.9	34	50.0	107	53.0	97	51.9		158	48.0			52	50.0	96	45.9
Fruit/Vegetable consumed
	4 or less servings/day	169	64.8	54	58.1	173	58.6	170	61.8		288	62.1	7	58.3	85	58.6	197	64.2
	5 or more servings/day	92	35.3	39	41.9	122	41.4	105	38.2		176	37.9	5	41.7	60	41.4	110	35.8
Starchy staples consumed
	1–4 servings/day	76	29.1	20	21.5	52	17.6	63	22.9		115	24.8	2	16.7	30	20.7	67	21.8
	5–9 servings/ day	123	47.1	43	46.2	150	50.9	142	51.6		228	49.1	6	50.0	79	54.5	163	53.1
	10+ servings/day	62	23.8	30	32.3	93	31.5	70	25.5		121	26.1	4	33.3	36	24.8	77	25.1
Ever taken alcoholic drink
	No	239	91.6	86	92.5	270	91.5	249	90.6		427	92.0	12	100.0	130	89.7	280	91.2
	Yes	22	8.4	7	7.5	25	8.5	26	9.5		37	8.0			15	10.3	27	8.8
Physical activity
	None	65	24.9	18	19.4	88	29.8	68	24.7		118	25.4	1	8.3	37	25.5	79	25.7
	1–4 days/week	102	39.1	34	36.6	113	38.3	96	34.9		183	39.4	4	33.3	53	36.6	109	35.5
	5 or more days/week	94	36.0	41	44.1	94	31.9	111	40.4		163	35.1	7	58.3	55	37.9	119	38.8
HIV status
	Negative	236	90.8	83	89.3	270	92.2	244	88.7		417	90.3	10	83.3	130	89.7	278	90.9
	Positive	24	9.2	10	10.8	23	7.9	31	11.3		45	9.7	2	16.7	15	10.3	28	9.2

Recovered¹ means child was stunted during pre-school years and normal from 7 years.

Rocovered²- child was wasted in pre-school years and normal from 7 years.

Deteriorated¹ means child was normal during pre-school years and became stunted from 7 years.

Deteriorated²- child was normal in pre-school years and became wasted from 7 years.

Table 2. Distribution of adolescent cardiovascular disease risk factors and schooling outcomes by nutritional status.

		Mean blood pressure (mmHg)			Mean Lipid level (mmol/L)
		Systolic	Diastolic	TC	TGs	HDL-C	LDL-C	HBA1c (%)	Schooling years
Nutritional status	Number	Mean (sd)	Mean (sd)	Mean (sd)	Mean (sd)	Mean (sd)	Mean (sd)	Mean (sd)	Mean (sd)
Height-for-age
Normal	261	119 (12.0)	70.4 (8.3)	3.6 (1.0)	1.2 (0.7)	1.0 (0.4)	2.0 (0.8)	3.8 (1.3)	9.0 (8.8)
Stunted	93	115 (11.5)	68.9 (8.8)	3.7 (0.9)	1.2 (0.5)	1.0 (0.3)	2.1 (0.7)	3.7 (0.6)	5.8 (3.0)
Recovered	295	118 (11.2)	70.1 (8.5)	3.7 (1.0)	1.2 (0.6)	1.0 (0.4)	2.1 (0.8)	3.7 (0.7)	8.4 (6.4)
Deteriorated	275	118 (11.9)	69.8 (8.5)	3.5 (0.9)	1.1 (0.5)	1.0 (0.4)	2.0 (0.7)	3.7 (0.6)	8.5 (11.5)
Weight-for-height
Normal	464	118 (12.3)	70 (8.1)	3.6 (1.0)	1.2 (0.6)	1.0 (0.4)	2.1 (0.8)	3.7 (1.1)	9.2 (11.0)
Wasted	12	111 (9.2)	67 (4.2)	3.8 (1.1)	1.1 (0.5)	1.2 (0.4)	2.1 (0.9)	3.6 (0.5)	6.2 (2.5)
Recovered	145	119 (9.7)	72 (8.4)	3.7 (1.0)	1.2 (0.6)	1.0 (0.4)	2.1 (0.8)	3.7 (0.7)	7.8 (3.8)
Deteriorated	307	117 (11.2)	69 (8.2)	3.5 (0.9)	1.2 (0.5)	1.0 (0.4)	2.0 (0.7)	3.7 (0.6)	7.6 (6.3)
Experienced both^a
Normal	269	117.7 (12.4)	69.8 (7.9)	3.6 (0.9)	1.2 (0.7)	1.0 (0.4)	2.0 (0.7)	3.7 (1.2)	9.8 (13.0)
Recovered	20	118.8 (9.7)	72.7 (8.8)	3.7 (1.0)	1.2 (0.5)	1.0 (0.4)	2.1 (0.7)	3.5 (0.5)	7.8 (4.2)
Never recovered	37	117.3 (10.3)	71,3 (8.3)	3.7 (1.0)	1.1 (0.5)	1.1 (0.4)	2.1 (0.8)	3.6 (0.6)	8.0 (3.3)

^aExperienced both wasting and stunting.

Table 3. Association between childhood stunting and blood pressure, and school achievement during adolescence (multivariate analysis).

		Systolic blood pressure (mmHg)		Diastolic blood pressure (mmHg)		Education attained (years)
Characteristic		Coefficient (95%CI)	p-value	Coefficient (95%CI)	p-value	Coefficient (95%CI)	p-value
Height- for- age change
Normal		Ref		Ref		Ref
Stunted all through		-2.90 (-6.41, 0.61)	0.10	-0.23 (-2.70, 2.22)	0.85	-2.82 (-5.48, -0.70)	0.04
Stunted but recovered		0.67 (-1.66, 3.00)	0.57	0.19 (-1.55, 1.92)	0.83	-1.04 (-2.97, 0.90)	0.29
Normal but later stunted		0.99 (-1.84, 3.84)	0.49	0.15 (-1.56, 1.87)	0.86	-0.12 (-2.09, 0.86)	0.90
Age groups (years)
13-14		Ref		Ref		Ref
15-16		0.67 (-1.66, 3,00)	0.57	-0.43 (-2.10, 1.23)	0.61	3.75 (1.91,5.56)	<0.01
17-19		0.99 (-0.92, -1.84)	0.49	0.60 (-1.35, 2.50)	0.54	4.91(2.79,6.87)	<0.01
Sex
Male		Ref		Ref
Female		-0.36 (-2.23, 1.50)	0.70	2.20 (0.69, 3.72)	0.01	0.87 (-0.69, 2.42)	0.28
Education
Incomplete primary		Ref		Ref
Completed primary		2.13 (-0.59, 4.85)	0.12	0.02 (-1.89, 1.94)	0.98
Post primary		-0.06 (-2.51, 2.46)	0.98	-0.42 (-2.2, 1.37)	0.65
Tribe
Muganda		Ref		Ref		Ref
Other		-2.14 (-4.40, 0.12)	0.06	-0.24 (-1.94, 1.46)	0.27	1.17 (-0.61, 2.95)	0.19
Wall type
Concrete and brick		Ref		Ref		Ref
Mud and brick		1.49 (-1.38, 4.37)	0.31	-1.18 (-2.91, 0.54)	0.17	0.08 (-1.98,-2.16)	0.87
Mud and pole		0.65 (-1.44, 2.85)	0.54	-0.28(-1.83, 1.27)	0.72	0.23 (-1.43, 1.90)	0.78
Reported alcohol consumption							0.29
No	Ref			Ref
Yes	6.57 (2.30, 10.84)		<0.01	2.34 (-0.37, 5.05)	0.09	Ref -1.15 (-3.30, 1.01)	0.29
Physical activity per week
None	Ref			Ref		Ref
1-3 times	1.17 (-1.51, 3.86)		0.39	0.33 (-1.50, 2.17)	0.72	-1.38 (-3.38, 0.62)	0.17
4 or more times	0.12 (-2.58, 2.83)		0.92	1.34 (-0.57, 3.26)	0.17	-2.28 (-4.42, -0.14)	0.04

Table 4. Association between childhood wasting and blood pressure, and school achievement during adolescence (multivariate analysis).

	Systolic blood pressure (mmHg)		Diastolic blood pressure (mmHg)		Education attained (years)
Characteristic	Coefficient (95%CI)	p-value	Coefficient (95%CI)	p-value	Coefficient (95%CI)	p-value
Weight- for- height change
Normal	Ref		Ref		Ref
Wasted all through	-7.90 (-14.52, -1.28)	0.02	-3.92 (-7.42, -0.38)	0.03	-1.91 (-4.51, 0.68)	0.04
Wasted but recovered	-0.12 (-2.52, -2.27) 0.02	0.02	1.93 (0.11, 3.74)	0.04	-2.05 (-3.30, -0.79)	<0.01
Normal but later wasted	-1.88 (-3.97, 0. 21)	0.08	-0.77 (-2.11, 0.26)	0.28	-1.50 (-3.17, 0.18)	0.08
Age groups (years)
13-14	Ref		Ref
15-16	1.42 (-0.85, 3,70)	0.22	-0.16 (-1.70, 1.38)	0.84	3.71 (2.14,5.28)	<0.01
17-19	190 (-0.92, 4.71)	0.19	0.61 (-1.28, 2.50)	0.53	4.99 (3.11,6.87)	<0.01
Sex
Male	Ref		Ref
Female	-0.60 (-2.39, 1.18)	0.51	1.78 (0.36, 3.21)	0.01	0.91 (-0.37, 0.16)	0.16
Education
Incomplete primary	Ref		Ref		Ref
Completed primary	2.22 (-0.52, 4.96)	0.11	0.19 (-1.67, 2.05)	0.84
Post primary	0.06 (-2.37, 2.49)	0.96	-0.26 (-2.02, 1.48)	0.76
Tribe
Muganda	Ref		Ref		Ref
Other	-2.68 (-4.99, -0.45)	0.02	-0.85 (-2.36, 0.66)	0.27	1.13 (-0.81, 3.07)	0.25
Wall type
Concrete and brick	Ref		Ref		Ref
Mud and brick	2.30 (-0.52, 5.12)	0.11	-0.14 (-1.79, 1.50)	0.86	0.16 (-1.80,-2.11)	0.87
Mud and pole	0.74 (-1.34, 2.85)	0.49	-0.25 (-1.74, 1.24)	0.74	0.40 (-1.19, 2.00)	0.61
Reported alcohol consumption
No	Ref		Ref		Ref
Yes	4.51 (0.46, 8.57)	0.02	1.31 (-1.13, 3.99)	0.28	-1.64 (-3.45, 0.15)	0.07