Growth dynamics of Indian infants using latent trajectory models in pooled survey datasets

Abstract

Abstract Background: National survey data show that growth faltering starts early in Indian children, and the early detection of growth trajectories is important for the prevention of later growth faltering. We aimed to identify and characterize distinct growth trajectories in the first year, in urban and rural Indian children. Methods: Pooled data from 5 interventional and non-interventional longitudinal studies across India were used for the analysis. Latent class mixed modeling (LCMM) was used to identify the groups of children with similar trajectories over age. Classes of children were created for length-for-age (LAZ) and weight-for-age (WAZ), based on place of birth, residential area, and maternal education. Results: We identified 2 and 3 latent trajectories for LAZ in boys and girls respectively, and 4 trajectories for WAZ in both boys and girls. The first trajectory for LAZ with the highest proportion of children (>80% of children), did not decline or increase with age; the boys trajectory was close to the WHO median while the girls trajectory was lower than the WHO median from birth. The LAZ trajectories of remaining boys and girls declined with age (slope, μdg=-1.04; 95% CI: -1.09, -0.99 for boys and μdg=-0.69; 95% CI: -0.76,-0.63 for girls). The first trajectory for WAZ (~50% of children) increased with age for boys (μdg=0.13; 95% CI: 0.11, 0.16) and girls (μdg=-0.64 (-1.14, -0.13), while in the remaining trajectories, WAZ declined with age. Conclusion: Distinct growth trajectories are present in Indian children in the first year. Identification of a faltering trajectory and associated modifiable factors can help with early preventive or corrective interventions.