Peer-reviewed article
Impact of linear growth-improving interventions on childhood overnutrition at 24 months: a randomized controlled trial.
Rukman Manapurath, Ranadip Chowdhury, Sunita Taneja, Nita Bhandari, Anura V Kurpad et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This randomized controlled trial in India tested whether interventions to prevent stunting (poor linear growth) in the first 1000 days of life would inadvertently cause childhood obesity. The interventions included health, nutrition, psychosocial support, and water and sanitation services delivered from pregnancy through early childhood. While children receiving interventions had higher body mass index scores at 24 months, actual overweight and obesity rates remained very low (0–1.3%), and the interventions improved growth without causing harmful weight gain.
Key points
- Comprehensive preconception-to-early-childhood interventions significantly improved linear growth and neonatal fat-free mass compared to routine care
- Children in intervention groups had higher BMI z-scores than controls, but prevalence of overweight/obesity was extremely low (0.0–1.3%)
- Pregnancy interventions significantly increased neonatal fat-free mass (mean difference 0.1 kg) with no significant increase in fat mass
- Interventions achieved growth improvements without causing overweight or obesity, aligning with WHO guidance on 'double-duty actions' for low- and middle-income countries
- Study enrolled children in low-to-middle-income populations and measured body composition at 1 month and 24 months of age
Limitations
The study measures only up to 24 months and does not follow children into later childhood, so longer-term effects on overweight and obesity cannot be assessed. The extremely low prevalence of overweight and obesity in the study population may limit generalisability to settings with higher baseline rates of childhood obesity.
Abstract
BACKGROUND: Childhood malnutrition, both undernutrition and overnutrition, is a major health concern in many low- and middle-income countries (LMICs). Efforts to reduce early undernutrition could also lead to obesity. In an earlier study, we reported the successful impact of a package of preconception, pregnancy, postnatal, and/or early childhood interventions (health, nutrition, psychosocial support, and water, sanitation, and hygiene) delivered in the first 1000 d, on reducing stunting in low-to-middle-income populations, in comparison with routine care. However, the impact of these interventions on early body composition and subsequent overweight is not known. OBJECTIVES: The objective of this study was to estimate the effect of a package of interventions directed at preventing stunting in the first 1000 d on body composition at 1 mo and childhood overweight and/or obesity at 24 mo of age. METHODS: Infant body composition was measured by deuterium dilution at 1 mo of age, along with the prevalence of childhood overweight and/or obesity at 24 mo, defined by a body mass index-for-Age Z (BMIz) score >+2 standard deviation. RESULTS: Children in the preconception, pregnancy, and early childhood intervention group and those in the pregnancy and early childhood intervention group had higher body mass index z scores than those in routine care. However, the prevalence of overweight and/or obesity was low (ranging from 0.0 to 1.3%). Pregnancy interventions significantly increased neonatal fat-free mass (mean difference 0.1 kg, 95% confidence interval [CI]: 0.01, 0.2). However, there was no significant change in fat mass. CONCLUSIONS: Comprehensive interventions from preconception to early childhood improve linear growth but do not result in overweight and/or obesity at 24 mo. With better resultant linear and ponderal growth, they converge with the World Health Organization's "double-duty actions for nutrition" for LMIC settings, where childhood overweight and/or obesity is a growing concern. This trial was registered at Clinical Trials Registry - India as CTRI/2017/06/008908.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Package of preconception, pregnancy, postnatal, and early childhood interventions including health, nutrition, psychosocial support, and water, sanitation, and hygiene delivered in the first 1000 days
- Population
- Infants and children in low-to-middle-income populations in India, measured at 1 month and 24 months of age
Key finding
Children in intervention groups had higher BMI z-scores than routine care controls, but overweight/obesity prevalence remained very low (0.0–1.3%)