Objectives End-stage chronic liver disease in children is associated with sarcopenia and aberrant adipose tissue mass. We investigated correlations between liver pathology-associated gene pathways (fibrosis, inflammation and steatosis) and metabolic genes in muscle and adipose tissue.Methods Liver, rectus abdominis muscle and subcutaneous adipose tissue were collected during liver transplant for microarray gene expression analysis. Patients underwent pre-transplant indirect calorimetry, anthropometry and laboratory assessments. Weighted gene co-expression network analysis identified highly correlated gene modules within each tissue and explored inter-tissue correlations.Results Nine patients were studied, three male:six female, age 7 months to 17 years. Liver gene clusters associated with fibrosis and ribosome function/protein secretion negatively correlated with muscle mitochondrial function genes and positively correlated with adipose tissue mitochondrial function genes. Notable correlations included a negative correlation between muscle growth hormone receptor (GHR) and liver ARID5B, MFGE8 and YWHAZ, and a positive correlation between adipose AKT1, ADG5, and SRM and liver RRAGA, YES1, EIF3M and COX3A. Liver inflammation-associated genes (vimentin, TIMP2, CXCL6 and endothelin-1) negatively correlated with adipose genes improving insulin sensitivity (THRSP) and fibrosis-related genes (KRT36, DMTN). Liver steatosis genes (ADRA2B) negatively correlated with adipose genes involved in adipogenesis (FGF10) and thyroid hormone metabolism (NHLH1).Conclusions Genes related to liver fibrosis and protein secretion negatively correlated with muscle and adipose tissue metabolism/proliferation genes. Liver inflammation and steatosis gene clusters were associated with muscle and adipose metabolism genes. This pilot study highlights important inter-tissue gene correlations warranting further investigation in paediatric end-stage chronic liver disease.

Background and objectives The relationship between daughters-in-law (DIL) and mothers-in-law (MIL) is often portrayed as conflictual, though from an evolutionary perspective, the two women could cooperate to gain Darwinian fitness benefits. We investigated this relationship in a society where it is central to women's social niche. Without asking directly, we aimed to evaluate markers of conflict and harmony in households, and whether variability in this balance was reflected in differential health outcomes. We also tested whether conflict was less likely in households with more children, and hence greater shared genetic interest.Methodology We studied 110 co-resident DIL-MIL dyads from rural lowland Nepal and compared anthropometry, physical and mental health, lived experience, agency, and attributed contributions to household tasks.Results Overall, DIL had better mental health than MIL, and greater weight and height. Tension over childcare and resting was common. Mental health and height differences within dyads were greater in households with inferred conflict over childcare, compared to inferred harmony households. DIL had better health outcomes and higher weight and height relative to MIL if they lived in conflict compared to harmony households, whereas MIL had better health outcomes if they lived in harmony households. Number of children did not predict conflict.Conclusions and implications Despite MIL being senior in the household, DIL reported lower stress and better mental health, especially in households with inferred conflict. DIL in such households also had better nutritional status. Having had time since marriage to consolidate their status in the household, DIL may have increased their agency and power.Lay summary Our study in rural Nepal aimed to identify which of daughter-in-law or mother-in-law held the upper hand in the household hierarchy, and how this was reflected in health outcomes. Although mothers-in-law are more senior, daughters-in-law had better physical and mental health, especially in households with inferred conflict over childcare.

OBJECTIVES:Childbirth complications occur if fetal size is excessive for the maternal birth canal. We hypothesized that young women's metabolic traits (organ and muscle mass, resting energy expenditure (REE)) known to promote fetal growth would correlate with dimensions of the birth canal, and that some of this association would be explained by growth markers (tibia length, height). MATERIALS AND METHODS:We analyzed cross-sectional data on anthropometry, organ mass (magnetic resonance imaging (MRI)), skeletal muscle (dual-energy X-ray absorptiometry), fat mass (4-component model), pelvic dimensions (MRI), and REE (indirect calorimetry) in 68 nulliparous women aged 20-28 years of South Asian ancestry living in the UK. Principal component analysis (PCA) was used to summarize variability in organ/muscle mass and pelvic dimensions (PCApelvis). Associations between metabolic and pelvic traits were assessed using Pearson correlations, and partial correlations adjusting for height or tibia length. RESULTS:Mean height was 161 cm and body mass index 22.3 kg/m2. There were positive correlations between REE, organ/muscle mass, head girth and the first PCApelvis score, which were partly explained by variability in tibia and height. Fat mass was associated with REE and organ/muscle mass but not pelvic dimensions. DISCUSSION:Correlations between metabolic and pelvic traits indicate a degree of coordination: women with greater metabolic capacity to promote fetal growth also have larger pelvic dimensions, partly explained by linear growth patterns. However, body fat in nulliparous women correlates with REE but not pelvic dimensions; hence high adiposity could increase risk of childbirth complications when these women give birth.

Life history theory seeks to understand how organisms distribute energy between physiological functions across the life course. A central assumption is that energy allocation involves 'trade-offs' between competing functions relating to defence, maintenance, reproduction, and growth. Constraints on human energy expenditure may produce trade-offs during energetic stress, affecting functions critical for homeostasis, survival, and reproduction. While there is some evidence for binary trade-offs between two functions in humans, no studies have tested physiological resource prioritisation across multiple functions under energetic constraint. This study empirically assessed multiple human life history trade-offs and the proximate biological mechanisms underpinning them. We recruited 147 ultra-endurance athletes (107 male, 40 female) participating in four environmentally diverse multiday ultramarathons and one multiweek ocean rowing event. The severe energetic demands of these competitions provide a valuable opportunity to provoke and observe detectable trade-offs. We found evidence of trade-offs across multiple functions. Specifically, investment in defence (as indexed by immune biomarkers) was broadly prioritised relative to investment in storage, reproduction and maintenance. Our results enhance current understanding of the role of phenotypic plasticity in human adaptability and have implications for athlete health and performance as well as the emerging discipline of evolutionary public health.

Human childbirth has often been considered uniquely difficult among mammals, yet recent evidence suggests that obstructed labor and fetopelvic disproportion are widespread across placental mammals. Here, we propose the "costly son" hypothesis: because male offspring are typically larger at birth, they impose greater obstetric risk on mothers and themselves by increasing the likelihood of fetopelvic disproportion and dystocia. We compiled sex-specific birth weight data for 140 placental mammal species across 11 orders and reviewed published evidence on sex differences in dystocia risk. Male neonates were more commonly larger at birth than females, and male-biased birth size differences were strongly associated with male-biased adult sexual size dimorphism. Species with male-biased adult size dimorphism had sixfold greater odds of exhibiting male-biased birth weight differences than species with female-biased dimorphism. Male-biased birth weight differences existed irrespective of developmental mode (precocial or altricial), indicating that sex differences in fetal growth arise early in gestation. Evidence from humans, livestock, and at least one non-human primate suggests that male fetal sex is associated with elevated dystocia risk, that is, precocial taxa where birth size approaches the mechanical limits of the maternal birth canal. We further hypothesize and discuss how parity and sex ratio adjustment may modulate these risks and associated trade-offs in a Trivers-Willard context. Our findings identify fetal sex as an underappreciated dimension of mammalian obstetrical dilemmas and suggest that the evolutionary benefits of producing larger sons are balanced by increased risks of birth complications and mortality.

ABSTRACT Objectives Maternal stress during childhood may contribute to childhood obesity through effects on parenting, parent–child relationships, or children’s stress responses. However, evidence is largely based on maternal self-reported stress, while studies using physiological measures like cortisol have found inconsistent associations. Most studies have been conducted in high-income settings, limiting generalisability. Using psychological and physiological stress markers, this cross-sectional study evaluates maternal stress exposures and child risk of obesity in 475 pairs of Peruvian women and their children, age 5-15 years, in a disadvantaged urban area. Methods Maternal stress exposures included mental distress (12-item General Health Questionnaire categorising moderate/high vs no/low distress) and allostatic load (AL; lower/moderate/higher AL assessed from Latent Profile Analysis of hair cortisol, BMI, waist circumference and blood pressure). Child outcomes included BMI and waist circumference-for-age z scores (BAZ and WCAZ). Linear regression analyses were conducted, adjusting for confounders. Results Versus mothers with no/low distress, those with moderate/high distress had children with 0.40 (95% CI: −0.66,−0.13) and 0.32 lower (−0.53,−0.11) child BAZ and WCAZ respectively. Versus lower AL mothers, moderate AL mothers had children with 1.15 (0.41,1.88) and 0.74 (0.20,1.28) greater BAZ and WCAZ while higher AL mothers had children with 1.43 (0.95,1.92) and 0.91 (0.50,1.32) greater BAZ and WCAZ respectively. Higher maternal cortisol independently predicted child adiposity. Conclusions Children of mothers with higher AL were at greater risk of overweight or obesity, which may add to the rising burdens of non-communicable diseases in resource-constrained settings as well as related social, economic, and public health costs.

Stunting affects approximately one-quarter of children worldwide. While the majority of these children live in Africa and Asia, a social gradient in height exists within high-income countries (HICs). In contrast to the coordinated focus on stunting in many low- and middle-income countries (LMICs), linear growth is not a public health priority in high-income settings. We reviewed the literature on relationships between linear growth and cardiometabolic outcomes (coronary heart disease [CHD], overweight/obesity, hypertension, and type 2 diabetes) and neurocognitive outcomes. We take a life-course approach, and use the “capacity load” model as a framework for understanding why stunting is associated with adverse cardiometabolic outcomes. We focus on the literature from HICs, but data from LMICs are included for context. Analysis of birth cohorts in high-, middle-, and low-income countries has consistently demonstrated relationships between early-life linear growth and downstream cardiometabolic and neurocognitive outcomes. These findings have been reinforced more recently by trial data. Birth size is associated with CHD, obesity, and type 2 diabetes, and with hypertension when small birth size is followed by accelerated postnatal growth. The patterns of postnatal linear growth associated with outcomes in adulthood are complex and context-dependent; both stunting and rapid linear growth in childhood are associated with cardiometabolic disease. We interpret these findings using the capacity-load model, a conceptual framework that describes the interactions between metabolic homeostatic capacity and metabolic load in shaping CHD risk. The strength and consistency of longitudinal associations between linear growth and several long-term deleterious outcomes across multiple settings and time points are striking. Future research should investigate both causal pathways and the potential for using height and growth velocity as markers for identifying children at increased risk of lifelong decrements in educational or cardiometabolic health outcomes who could benefit from early intervention.

BACKGROUND AND AIMS:Sarcopenic obesity (SO) has been proposed as a risk factor for cognitive impairment. Yet evidence is inconsistent and often limited by heterogeneous definitions and lack of longitudinal assessments. This study aimed to examine associations of SO with all-cause and subtype-specific dementia, and to assess dose-response patterns and how longitudinal changes in body composition and muscle strength relate to dementia risk. METHODS:We included 489,972 adults (mean age 56.5 ± 8.1 years) followed for a median of 13.6 years. SO was defined using the Sarcopenic Obesity Global Leadership Initiative (SOGLI) criteria. Cox models estimated hazard ratios (HRs) for all-cause dementia, Alzheimer's disease (AD), and vascular dementia. Restricted cubic spline (RCS) analysis assessed dose-response associations. Landmark analyses among 54,070 participants (median follow-up 4.1 years) evaluated how longitudinal changes in handgrip strength (HGS) and body composition related to subsequent dementia risk. RESULTS:SO (HR = 1.34; 95% CI: 1.18-1.52) and sarcopenia (HR = 1.30; 95% CI: 1.14-1.48) were associated with higher all-cause dementia risk compared with the non-sarcopenic, non-obesity group, whereas obesity alone was associated with lower risk (HR = 0.91; 95% CI: 0.84-0.99). Age and sex modified these associations, with stronger associations observed among adults younger than 65 years and more pronounced risk elevations for sarcopenia (HR = 1.37; 95% CI: 1.07-1.75) and SO (HR = 1.55; 95% CI: 1.29-1.87) in males, whereas obesity showed inverse associations with dementia risk primarily in females (HR = 0.81; 95% CI: 0.71-0.92). RCS analyses showed J-shaped associations between fat mass percentage (%FM) and dementia risk in males, lower dementia risk at higher levels of %FM in older females, and strong inverse associations between HGS and dementia risk in both sexes. Landmark analyses showed that declines in HGS consistently predicted all-cause dementia. CONCLUSION:SO and sarcopenia are associated with dementia risk. HGS is a significant predictor of dementia risk supporting the inclusion of measures of muscle function in dementia prevention strategies.

IntroductionEndurance activity is considered a hallmark of human evolution, but there is limited understanding of what constrains this capacity. The renal demands of endurance exercise often elicit cellular damage, and renal functional capacity is shaped by fetal growth, but whether birth weight (BW) directly affects exercise-induced renal damage is unknown.MethodsHere, we test the extent to which birth weight shapes change in serum creatinine, a marker of kidney function, among 44 ultramarathon athletes racing in hot or cold conditions.ResultsOn their own, sex, age, distance run, hydration status, and muscle damage explained ~33% of the variance in absolute creatinine change (p=0.009). The addition of linear and quadratic mean-centered birth weight terms and ultramarathon race significantly improved the model fit (p<0.01), explaining ~58% of the variance in absolute creatinine change across the races (p<0.001). In this model, hydration status and both birth weight terms were the significant predictors of creatinine change (all p<0.05), indicating that both low and high birth weights were associated with a higher chance of transient elevation in creatinine after prolonged exercise. Holding all other variables constant, birth weight influences the kidney’s response to endurance exercise in a U-shaped manner, with the lowest increases in creatinine predicted at birth weights of ~3.8 kg.DiscussionRenal functional capacity, proxied by BW, may thus have been central in constraining the upper limits of endurance activity in human evolution, helping us to understand why not just inadequate, but too much, physical activity can impair health.

INTRODUCTION:We aimed to determine the association between paternal labour migration and the growth of the left-behind children in Dhanusha district, Nepal, where child stunting and international labour migration are highly prevalent. METHODS:We used growth data at birth, 6 months, 1 year and 2 years from a birth cohort study conducted 2012-2014, and growth data at age 6 years collected in 2018. We collected household migration history data to determine the children's exposure to paternal migration. The primary outcome was child length/height-for-age z-score (HAZ). Children's body circumferences, skinfold thicknesses, body composition, tibia length and grip strength were secondary outcomes measured at 6 years. We tested (i) the overall association between paternal international migration and the growth of the left-behind child; the roles of (ii) the duration of migration (≤12 mvs >12 m) and (iii) child age (≤6 mvs 12-72 m) as moderating factors; (iv) the association between receipt of remittances from the migrant father and child growth outcomes; and (v) stratified the main analyses by child gender. We fitted mixed-effects linear regression models for longitudinal data and linear regression models for cross-sectional data, adjusted for potential confounders. RESULTS:Analysing across all time points, daughters of labour migrants had lower HAZ than daughters of non-migrants (-0.13, 95% CI -0.24 to -0.03), but no overall association was found in boys. The negative associations were largest at <6 m (girls: -0.23, 95% CI -0.41 to -0.05), but in boys only if the father had recently (≤12 m) migrated (-0.26, 95% CI -0.51 to 0.00). Children of migrants showed a tendency towards smaller body sizes compared with children of non-migrants. We found no association between remittances and any measure of child growth. CONCLUSIONS:Interventions should target support for pregnant women and mothers with young infants to provide gender-equitable childcare, especially if their husband just left for work overseas.

ABSTRACT Upstream pathways influencing child growth are complex. Weight‐for‐age z‐score (WAZ) reflects both ponderal and linear growth and can identify children at high mortality risk. Using data from a prospective cohort of 326 mother‐child pairs in Kenya, we evaluated whether associations between maternal exposures and child growth outcomes in early and later childhood. Growth trajectories were examined using locally weighted scatterplot smoothing and piecewise linear mixed‐effect models with a knot at age 3 months. Poisson regression models examined associations between maternal characteristics and child underweight (WAZ < −2) and stunting (LAZ < −2) before and after 3 months. Mean WAZ increased to a peak at 3 months before declining steadily through 24 months. Lower maternal education (adjusted β [aβ] −0.18; 95% CI: −0.24, −0.13), household crowding (aβ −0.2; 95% CI: −0.28, −0.11), lower wealth quintile (aβ −0.04; 95% CI: −0.06, −0.02) and multiparity (aβ −0.16; 95% CI: −0.23, −0.1) were associated with lower monthly rate of change in WAZ prior to age 3 months. Younger maternal age was associated with an increased monthly rate of change in WAZ (aβ = 0.13; 95% CI: 0.08, 0.18) before 3 months and decreased monthly WAZ (aβ −0.02; 95% CI: −0.03, −0.01) after 3 months. Preterm birth was associated with increased risk of underweight in both periods (aRR 2.77; 95% CI: 1.39–5.50). Maternal mental health, intimate partner violence and adverse childhood experiences were not significantly associated with child growth. Maternal nutritional, socio‐economic and household‐level factors shape early growth, emphasising the need for cross‐sectoral programs to support growth.

BACKGROUND:As the threat of child malnutrition increases, the focus remains mostly on short-term consequences. Long-term sequelae are increasingly recognised but lack strong evidence, and many studies face methodological limitations. METHOD:A retrospective cohort of survivors of the 1984-1985 Great-Ethiopian Famine was compared with two novel control groups: born post-famine; and age category- and sex-matched controls. Exposure to famine at different age categories was explored (fetal, 0-2, 2-5, 5-10 and 10-18 years). Follow-up was 40 years later. Outcomes included anthropometry, body composition, arterial stiffness, mental health, and risk of cardiometabolic and non-communicable diseases (NCDs). Adjusted differences and 95% CI between exposed and controls were calculated. RESULTS:Compared with matched and post-famine controls, adjusted differences (95% CI) for exposed group were: height, -1.4 cm (-2.4 to -0.3) and -2.4 cm (-3.7 to -1.1); weight, -1.4 kg (-2.7 to -0.1) and -1.7 kg (-3.3 to -0.1); diastolic blood pressure (DBP), -2.8 mm Hg (-4.4 to -1.1) and 2.8 mmHg (0.9 to 4.7); handgrip strength, -1.7 kg (-2.7 to -0.6) and -4.1 kg (-5.5 to -2.7); brachial augmentation index, 5.4% (0.3% to 10.5%) and 16.1% (10.1% to 22.1%); aortic augmentation index, 6.0% (1.5% to 10.4%) and 11.7% (6.1% to 17.3%); subscapular skinfold thickness, 1.1 mm (0.2 to 1.9) and 1.2 mm (0.1 to 2.3); triceps skinfold thickness, 1.8 mm (0.8 to 2.7) and 2.1 mm (1.0 to 3.3) and waist-to-height ratio, 0.01 (0.003 to 0.02) and 0.01 (0.001 to 0.02), respectively. When comparing risk by timing of exposure, individuals exposed during early childhood (0-2 years), preschool age (2-5 years), and late childhood (5-10 years) had reduced adult stature of -2.8 cm (-4.8 to -0.9), -2.8 cm (-4.7 to -0.9) and -2.1 cm (-4.0 to -0.2), respectively, and increased triceps skinfold of 1.7 mm (-0.5 to 3.8), 3.2 mm (0.8 to 5.6) and 3.8 mm (1.6 to 6.02), respectively. CONCLUSIONS:Early-life famine exposure is associated with smaller adult size and several, but not all NCD risks. Lower DBP in survivors compared with matched controls is surprising and might reflect differential susceptibility to specific later-life health risks. Greater arterial stiffness underscores the need to identify both preclinical and clinical risk. In contrast to exposure in utero, risk was higher among those exposed during early childhood (0-2 years), preschool (2-5 years) and late childhood (5-10 years). The study underscores the need for a dual approach in low- and middle-income settings: tackling the immediate undernutrition while also anticipating and mitigating long-term NCD risk in populations exposed to early-life severe malnutrition or famine.

Malnutrition during pregnancy is associated with adverse birth outcomes, but the importance of maternal diet during pregnancy for neonatal body composition remains inconclusive. This study investigated the role of maternal diet during pregnancy for neonatal body composition in the Ethiopian iABC birth cohort. The data stemmed from the first visit at birth comprising 644 mother-child pairs. Shortly after delivery, the diet of the last week of pregnancy was assessed by a non-quantitative and non-validated 18-items food frequency questionnaire. Multiple imputation was used to handle missing data. Twin births and implausible values were excluded from analysis (n = 92). The Dietary Diversity Score (0–9 points) was constructed and exploratory dietary patterns were derived via principal component analysis. Neonatal fat mass and fat-free mass were assessed by air-displacement plethysmography. The associations of maternal Dietary Diversity Score and exploratory dietary patterns with gestational age, neonatal anthropometric measures and body composition were investigated using multiple-adjusted linear regression analysis. In this cohort (n = 552), mean ± standard deviation (SD) mother’s age was 24.1 ± 4.6 years and the median maternal Dietary Diversity Score was 6 (interquartile range = 5–7). An ‘Animal-source food pattern’ and a ‘Vegetarian food pattern’ were identified. The mean ± SD birth weight was 3096 ± 363 g and gestational age was 39.0 ± 1.0 weeks. Maternal adherence to the Animal-source food pattern, but not Vegetarian food pattern, was related to birth weight [79.5 g (95

IntroductionGlobally in 2024, 1 in 5 women aged 20–24 years worldwide had been married before the age of 18 years. One reason for this persistent prevalence of underage marriage may be the slow change in social norms relating to education levels and women's marriage age. However, we know little about how norms change, and whether they vary by socio-demographic characteristics. We aimed to investigate changes in social norms across generations in rural Maharashtra, India.MethodsTo understand the status quo, we identified education levels and marriage ages typical of contemporary young adults in rural Maharashtra using the National Family Health Survey. To see if norms have shifted across generations, we analysed data on education and marriage age in 659 parent-adolescent dyads from the Pune Maternal Nutrition Study (PMNS) in rural Maharashtra. To ascertain if norms might shift in the future, we investigated adolescents' aspirations for their future hypothetical children's education and marriage, and classified adolescents as wanting (a) their children to decide themselves, (b) more education and later marriage age, or (c) the status quo. We assessed whether these aspirations differed by socio-demographic characteristics.ResultsCompared to the status quo and PMNS adults, PMNS adolescents had substantially more education, and girls were marrying slightly later. About 70% of the adolescents wanted their children to themselves decide their schooling. The remainder of both sexes wanted their children to have the same education as them (15 years). Only 10% of adolescent girls and 14% of boys wanted their child to decide their own marriage age. Most adolescents wanted a later marriage age for their children than their own experience. Lower educated and early married girls aspired for greater education for their children. More educated boys aspired for later marriage for their children.DiscussionEducation norms have changed by a larger magnitude than marriage age norms. Adolescents are already attaining their education aspirations, but aspire for later marriage of their children, more so for their hypothetical sons than daughters. Since senior household members remain influential in marriage decisions, it may take time before adolescents' aspirations for their children become a new norm.

OBJECTIVES:Video gaming is highly prevalent among university students, yet its health associations remain poorly understood. This study examined relationships between video gaming frequency and health in Australian university students. METHODS:A cross-sectional survey of 317 Western Australian university students assessed gaming habits, diet quality (Diet Quality Tool), physical activity (International Physical Activity Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), eating behaviors (Three-Factor Eating Questionnaire), and perceived stress (Perceived Stress Scale). Participants were categorized into tertiles based on gaming frequency (low [0-5 h/wk], moderate [6-10 h/wk], and high [>10 h/wk]). RESULTS:High-frequency gamers had significantly poorer diet quality scores (median 45.0 versus 50.0, P < 0.001), higher BMI (median 26.3 versus 22.2 kg/m², P < 0.001), and worse sleep quality (PSQI score 7.0 versus 6.0, P < 0.001) compared to low-frequency gamers. Correlation analyses confirmed these associations in which gaming frequency negatively correlated with diet quality (r = -0.26, P < 0.001) and physical activity (r = -0.13, P = 0.03) and positively correlated with BMI (r = 0.38, P < 0.001). Multiple regression analysis revealed total gaming hours independently predicted poorer diet quality (β = -0.16, P = 0.02) after controlling for demographic and lifestyle factors. CONCLUSIONS:Higher video gaming frequency was associated with poorer diet quality and increased BMI among university students. These findings suggest excessive gaming may contribute to adverse health outcomes. Public health interventions targeting excessive or high gaming levels and promoting healthy lifestyle habits in university populations are warranted.

This study aimed to identify linear growth trajectories from 0 to 5 years and assess their associations with cognitive function and school achievement in Ethiopian children aged 10 years. Latent class trajectory modelling was used to identify distinct height-for-age (HAZ) trajectories. Cognitive function was assessed using the Peabody Picture Vocabulary Test, while school achievement was measured by math, English and science (MES) combined scores and grade-for-age. Associations were assessed using multiple linear or logistic regressions. We identified four distinct HAZ trajectories. Decreasing trajectory (n 145, 31·9 %) started high at birth but dropped sharply. The increasing-decreasing trajectory (n 196, 43·2 %) increased up to 3 months, followed by a decrease. The stable low (n 74, 16·3 %) had low HAZ at birth, followed by a slight decrease. The rising trajectory (n 39, 8·6 %) started low but then increased to HAZ above, yet close to zero. At 10 years, children in the rising trajectory had 4·54 (95 % CI: -0·45, 9·55, P = 0·075) higher MES combined score and 2·4 times (95 % CI: 1·12, 5·15, P = 0·025) higher odds of being in the appropriate grade-for-age compared to those in the increasing-decreasing trajectory. The association between stable low and decreasing trajectory with appropriate grade-for-age had odds ratio close to null. In conclusion, we found that three of the four linear growth trajectory classes showed a declining pattern. Data suggest that greater linear growth in early childhood may be associated with higher school achievement and better cognitive function.

BACKGROUND:Severe acute malnutrition (SAM) is one of the main causes of child mortality, but little is known about the condition of the offspring of survivors. OBJECTIVES:This study aimed to describe the nutritional status of children born to mothers who were exposed to childhood SAM. METHODS:This was an observational cohort study of children aged 6-59 mo drawn from the Lwiro cohort in Democratic Republic of Congo (DRC) from March to May 2019. Exposure was defined as having a mother exposed to childhood SAM or not. We measured anthropometric parameters (weight, height, middle upper arm circumference) and edema to evaluate malnutrition. Child health indicators were assessed, as well as hemoglobin, human immunodeficiency virus serology, and parasitic infestation rates. Linear, binary, and ordinal logistic regressions with clustered robust standard errors were used to analyze differences between exposed and unexposed for continuous and dichotomous variables and malnutrition, respectively. RESULTS:A total of 178 exposed and 124 unexposed children were included. Median age of exposed and unexposed children was 27.1 mo and 24.3 mo, respectively. Females were 47.2% exposed and 54.0% unexposed (P = 0.161). Global acute malnutrition (GAM) and SAM were respectively 31.4% and 12.9% in exposed compared with 15.4% and 6.5% in unexposed [odds ratio (OR): 2.50; 95% confidence interval (CI): 1.36, 4.59; P = 0.003]. Stunting was 54.5% in exposed compared with 39.5% in unexposed (OR: 1.79; 95% CI: 1.11, 2.89; P = 0.018). Underweight was 32.0% in exposed compared with 19.4% in unexposed (OR: 2.02; 95% CI: 1.14, 3.56; P = 0.015). Adjusting for household type, age, and maternal body mass index, we observed persistence of GAM prevalence with SAM in unexposed 14.2 (95% CI: 8.3, 20.2), compared with 6.5 (95% CI: 2.9, 10.1) in unexposed, P = 0.010. No significant differences in prevalence were observed for anemia and intestinal parasitosis. CONCLUSIONS:In DRC, children whose mothers had been exposed to childhood malnutrition had a higher prevalence of malnutrition than children born to unexposed mothers. GAM and stunting exceed the extreme severity threshold set by the World Health Organization.