Peer-reviewed article
Maternal socioeconomic status and early childhood growth and nutrition in the PERSIAN Birth Cohort with insights into the double burden of malnutrition.
Golnaz Rezaeizadeh, Mohammad Ali Mansournia, Maryam Sharafkhah, Seyede Shahrbanoo Daniali, Navid Danaei et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how a mother's socioeconomic status affects child growth and nutrition in Iranian children from birth to age two using data from 7,169 infants. Children from higher-income families had better height and weight outcomes and were less likely to be underweight or stunted. However, the wealthiest families also showed higher obesity risk by age two. The research highlights a 'double burden of malnutrition' where poor nutrition and obesity can both exist, and how unbalanced growth patterns increase obesity risk.
Key points
- Higher maternal socioeconomic status consistently prevented underweight and stunting, with the strongest protective effects in the very high SES group
- By 24 months, children from the highest socioeconomic status group showed a significant increase in obesity risk
- Imbalanced growth patterns—where height and weight increase unevenly—appear to heighten obesity risk within higher SES groups
- The impact of socioeconomic status on child body mass index increased with age, peaking at 24 months
- Mathematical modelling comparing different growth ratios revealed how HAZ and WAZ patterns together predict obesity emergence
Limitations
The study is observational and cannot establish causation; it describes associations between socioeconomic status and growth patterns in an Iranian cohort, so findings may not generalise to other populations or contexts.
Abstract
In low- and middle-income countries, undernutrition often coexists with rising obesity, creating a double burden of malnutrition (DBM). Our study employs a mathematical approach to examine how maternal socioeconomic status (SES) impacts child growth in Iranian children from infancy to age two, offering new insights into strategies for tackling both undernutrition and obesity. We used data from the PERSIAN Birth Cohort. SES was divided into quintiles using multiple correspondence analysis (MCA), and child growth was assessed with eight indicators. Missing data were handled via multiple imputation (MI). SES impacts on growth were analyzed using Generalized Estimating Equations (GEE), and BMI-Z was predicted from WAZ and HAZ through linear regression by SES and age. We explored obesity risk by comparing HAZ-to-WAZ ratios from GEE models with WAZ-to-HAZ beta ratios from regressions. Sensitivity analyses compared MI with complete-case analyses (CCA). 7169 neonates were assessed at 2, 4, 6, 12, and 24 months. SES increasingly improved WAZ with age, preventing underweight in higher SES groups. SES consistently improved HAZ, significantly enhancing stunting prevention in higher SES groups. The impact on BMI-Z increased with age, peaking in Very High SES, which shows a significant rise in obesity risk by 24 months. Comparing ratios from GEE and regression models, we found that GEE ratios were lower where BMI-Z increased. Sensitivity analysis confirmed MI and CCA consistency. Addressing DBM requires understanding how imbalanced increases in HAZ and WAZ heighten obesity risk. Future research should focus on targeted interventions to manage DBM effectively.