Summary
In this paper we review the associations between maternal and child undernutrition
with human capital and risk of adult diseases in low-income and middle-income countries.
We analysed data from five long-standing prospective cohort studies from Brazil, Guatemala,
India, the Philippines, and South Africa and noted that indices of maternal and child
undernutrition (maternal height, birthweight, intrauterine growth restriction, and
weight, height, and body-mass index at 2 years according to the new WHO growth standards)
were related to adult outcomes (height, schooling, income or assets, offspring birthweight,
body-mass index, glucose concentrations, blood pressure). We undertook systematic
reviews of studies from low-income and middle-income countries for these outcomes
and for indicators related to blood lipids, cardiovascular disease, lung and immune
function, cancers, osteoporosis, and mental illness. Undernutrition was strongly associated,
both in the review of published work and in new analyses, with shorter adult height,
less schooling, reduced economic productivity, and—for women—lower offspring birthweight.
Associations with adult disease indicators were not so clear-cut. Increased size at
birth and in childhood were positively associated with adult body-mass index and to
a lesser extent with blood pressure values, but not with blood glucose concentrations.
In our new analyses and in published work, lower birthweight and undernutrition in
childhood were risk factors for high glucose concentrations, blood pressure, and harmful
lipid profiles once adult body-mass index and height were adjusted for, suggesting
that rapid postnatal weight gain—especially after infancy—is linked to these conditions.
The review of published works indicates that there is insufficient information about
long-term changes in immune function, blood lipids, or osteoporosis indicators. Birthweight
is positively associated with lung function and with the incidence of some cancers,
and undernutrition could be associated with mental illness. We noted that height-for-age
at 2 years was the best predictor of human capital and that undernutrition is associated
with lower human capital. We conclude that damage suffered in early life leads to
permanent impairment, and might also affect future generations. Its prevention will
probably bring about important health, educational, and economic benefits. Chronic
diseases are especially common in undernourished children who experience rapid weight
gain after infancy.