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

• Published in: Global health action Vol. 12; no. 1; p. 1626184
• Main Authors: Asiki, Gershim, Newton, Robert, Marions, Lena, Kamali, Anatoli, Smedman, Lars
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2019; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Academic achievement; adolescence; Adolescent; Adolescents; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Child development; Child hood undernutrition; Child Nutrition Disorders - complications; Child, Preschool; Childhood; Children; Clustering; Cohort analysis; Cohort Studies; Educational Status; Female; Growth Disorders - complications; Health risk assessment; Health risks; Health Status; Households; Humans; Lipids; Long term; Low income areas; Low income groups; Male; Malnutrition; Medicin och hälsovetenskap; Original; Poverty - statistics & numerical data; Recovery; Retrospective Studies; Risk Factors; Rural communities; Rural Population - statistics & numerical data; schooling; Uganda; Uganda; adolescence; blood pressure; Uganda; Child hood undernutrition; schooling
• ISSN: 1654-9716; 1654-9880; 1654-9880
• DOI: 10.1080/16549716.2019.1626184

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.