Risk Factors for Rapid Growth in Undernourished Children: Analysis of Indonesian Family Life Survey

Background. Children who suffer from undernutrition would grow rapidly to catch-up-growth after improvement in nutrition intake. However, this rapid growth during early life might have harmful effects on children's long-term health. Rapid growth, which is too fast, increases the risk of cardiovascular disease and obesity.

Objective. To determine the prevalence and analyze the risk of rapid growth in children, particularly who experienced undernutrition in 1000 first days of life, compared to well-nourished children.

Methods. This cohort study used data from the second and third waves of the Indonesia Family Life Survey (1997 and 2000). A total of 671 children aged 0 to 23 months in 1997 and 3 to 5 years in 2000 were included in this study. Rapid growth was determined as a change in length- or height-per-age and weight-per-age z-score greater than 0.67, based on WHO Child Growth Standard between years of follow-up. The anthropometric measurements were conducted by trained health workers. Children with history of low birth weight, stunting, underweight, and/or wasting were categorized as undernourished children. We used a logistic regression model to identify the risk of rapid growth in children among undernourished and well-nourished children, adjusted by characteristics of children, parents, and the household socioeconomic status.

Results. The prevalence of rapid growth in length/height and weight in undernourished children was 44.56% and 35.2%, respectively. The odds of undernourished children to grow rapidly in length/height compared to well-nourished children was 6.36 (95% CI 3.94,10.26; p = 0.000) after being controlled by socio-demographic characteristics. There was a higher odd 5.7 (95% CI 3.4, 9.5; p = 0.000) of rapid growth in weight in undernourished children. The odds of rapid growth in height increased significantly in children aged 12 to 23 months and children with mothers who had lower education levels. Furthermore, the odds of rapid growth in weight-for-age increased significantly in all children whose fathers had lower education levels.

Conclusion. This study adds to the evidence that there is an increased risk for rapid growth in length/height and weight in undernourished children and the risk was higher among older children aged 12 to 23 months. The study also found that maternal education was related to the risk of rapid growth in height and paternal education was strongly related to the risk for rapid growth in weight.