(P04-015-25) Childhood Growth Stunting Is Associated With Long-Term Metabolic Efficiency: Analysis of Multicountry Database

Objectives: The prevalence of childhood obesity continues to increase worldwide and poor growth early in life (i.e. linear growth restriction, LGR, or stunting) has been associated with an increased risk for obesity. The objective of this study was to determine the relationship between LGR and components of energy expenditure as possible predictors of obesity.

Methods: Data used for this study were derived from the Doubly Labeled Water (DLW) Global Database. LGR was defined using the WHO cutoff of stunting (HAZ < -2.00) and height-for-age (HAZ) as continuous variable. Children with HAZ < -4.00 or < 4.00 were excluded from the analyses.  Total energy expenditure (TEE) was assessed using DLW, basal energy expenditure (BEE) was measured by indirect calorimetry, respiratory quotient (RQ) was calculated as CO₂ expired/O₂ inspired, and physical activity level (PAL, TEE/BEE). Statistical methods included independent sample t-test and linear regression analyses.

Results: A total of 2233 children studied with a mean age of 10.9 ± 4.4 years, height of 142.4 ± 24.8cm, weight of 42.0 ± 21kg, HAZ of 0.20 ± 1.29, and BAZ of 0.40 ± 1.20. For energy expenditure and body composition, mean values were 8.9 ± 3.4MJ for TEE, 5.68 ± 1.84MJ for BEE, and 1.72 ± 0.37 for PAL, with a mean fat free mass (FFM, kg) and fat mass (FM, kg) of 30.1 ± 14.8 and 11.9 ± 9.0, respectively.  Stunting was not associated with any component of TEE, but HAZ was positively associated with PAL (β= 0.03, p=0.021), independent of FFM and FM.  RQ was significantly higher in stunted v. non-stunted children, 0.91 ± 0.04 v. 0.89 ± 0.03 (p < 0.001). Using linear regression, stunting and HAZ were both significant predictors of higher RQ (β= -0.02, p=0.003) and (β= -0.005, p=0.008), independent of FFM and FM.

Conclusions: Based on these data, children who grow poorly engage in less spontaneous physical activity and their metabolism may favor carbohydrate oxidation with less fat oxidation. The results extend previous reports of adaptions in energy metabolism in stunted children that favor energy deposition due to low fat oxidation. Data for this study are hosted at https://doubly-labelled-waterdatabase.iaea.org/home.

Funding Sources: None to report.