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COMMENTARY
Year : 2014  |  Volume : 58  |  Issue : 2  |  Page : 110-112  

Designing new growth charts for low-birth weight babies: Need of the hour in India


1 Post-Graduate Student, Department of Community Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
2 Assistant Professor, Department of Community Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
3 Director Professor, Department of Community Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

Date of Web Publication12-May-2014

Correspondence Address:
Dr. Pritam Roy
Post-Graduate Student, Department of Community Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.132286

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   Abstract 

Literature reveals theories explaining low birth weight (LBW) babies' unplanned catch-up growth is related to several non-communicable diseases (NCDs) in adult-life. Is the current growth chart as per World Health Organization child growth standards of healthy breast feed infants and young child is applicable for even LBW or small for gestational age babies? There are high chances that these LBW babies who are growing "in their centiles" will be diagnosed as mild or moderate protein energy malnutrition (PEM) in clinical settings as the current diagnostic criteria for PEM do not include birth weight as an indicator. Besides they are encouraged for home based extra caloric food to gain weight and thereby encouraging them to "crossing the percentile" in the growth curve. Do these managements really benefit the baby or are we inadvertently exposing them to increased future risk of adult diseases must be considered seriously. Thus, we may require revision to make a separate standardized growth chart for LBW babies indicating how they should grow.

Keywords: Growth chart, Low birth weight babies, Non-communicable disease


How to cite this article:
Roy P, Goel MK, Rasania SK. Designing new growth charts for low-birth weight babies: Need of the hour in India. Indian J Public Health 2014;58:110-2

How to cite this URL:
Roy P, Goel MK, Rasania SK. Designing new growth charts for low-birth weight babies: Need of the hour in India. Indian J Public Health [serial online] 2014 [cited 2019 Jun 19];58:110-2. Available from: http://www.ijph.in/text.asp?2014/58/2/110/132286

The World Health Organization (WHO) has defined low birth weight (LBW) as a weight of <2500 g. LBW babies carry an increased risk of morbidity and mortality both in the perinatal period and in later life. In the perinatal period, these manifestations include respiratory complications, hypotension, hypoglycemia, necrotizing enterocolitis, and neonatal sepsis. Furthermore, the pattern of growth is different in LBW babies when compared to normal babies. LBW babies show "catch up growth" that is a growth with velocity greater than the median for chronological age and gender or over statistical limits of normality for that age. [1] However in recent past, many of the researchers had also shown that among LBW babies unplanned catch-up growth is related to the occurrence of several non-communicable diseases (NCDs) in adult-life.

Different theories have been proposed to explain the relationship of the birth weight and weight gain with the development of diseases of adulthood. These are explained as follows:

The fetal origins of adult disease (FOAD) hypothesis: This hypothesis suggested that risk factors from intrauterine environmental exposures affect the fetus development during sensitive periods and increase the risk of specific diseases in adult life. If the fetus remains undernourished then it will develop insulin resistance and other metabolic changes as a strategy for immediate survival, for which it had to pay a price later in life on exposure to plentiful nutrition; also called as "thrifty phenotype" hypothesis. [2]

Thrifty genotype hypothesis: Neel suggested that diabetes was caused by "thrifty genes" [3] which were naturally selected for better survival during the distant past when the supply of food was precarious. He suggested that these genes conveyed a "fast insulin trigger" and resulted in the ability to store food rapidly as fat, which became diabetogenic in the modern setting of plentiful nutrition, later in life.

Predictive adaptive response hypothesis: According to this, the fetus made adaptations in-utero or during the early postnatal period, based on the predicted post-natal environment. When the predictive adaptive response is appropriate the phenotype was normal, however, when the predicted and actual environments did not match, disease get manifested. [4]

Epigenetic theory/framework of life-course epidemiology: According to the "thrifty phenotype" hypothesis, there should not be an increased risk for non-insulin dependent diabetes among LBW babies who grow with scarcity of food. The same LBW babies would, however, be at increased risk growing up in an area of affluence. Hence, the intrauterine exposure will only actualize its inherent harmful potential in interaction with later exposures. This reformulation of the FOAD hypothesis is called as epigenetic and the framework of "life-course epidemiology." [5]

In many studies, it have been observed that the LBW is associated with a higher risk several NCDs like-metabolic syndrome, cardiovascular diseases, as well as adverse effects on pulmonary, renal, and cerebral function and is influenced by the path of childhood growth. [6],[7],[8] But, the majority of these studies mainly addressed the European/American populations. Do the above mentioned theories relevant for Indian population too in explaining increase burden of NCDs? On the basis of following [Table 1], we can say that that the above theories also hold well in Indian settings.
Table 1: Summary of Indian studies on adulthood diseases and growth pattern among low birth weight babies

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Though, we have several studies and hypothesis addressing the relationship between the occurrence of several disease conditions with LBW and also with the pattern of weight gain, yet we have no sufficient information regarding how the pattern of growth should be advocated in these individuals.

World Health Organization had recently devised new growth chart and it had been adopted by Integrated Child Development Services (ICDS) in India. These are based on 9440 healthy breast feed infants and young child. It represents the highest quality knowledge available today on how children should grow and develop. Is the current growth chart used by ICDS in India as per WHO child growth standards, healthy breast feed infants and young child is applicable for even LBW or Small for gestational age babies? There are high chances that these LBW babies who are growing "in their centiles" will be diagnosed as mild or moderate Protein energy malnutrition (PEM) in clinical settings as the current diagnostic criteria for PEM do not include birth weight as an indicator. And as per present management they are encouraged for home based extra caloric food to gain weight and thereby encouraging them to "crossing the percentile" in the growth curve. Do these managements really benefit the baby or are we inadvertently exposing them to increased future risk of adult diseases must be considered seriously. We may require revision of the facts or to plan some research, to make growth charts specifically for LBW babies, thereby standardizing the optimum growth pattern for LBW babies; indicating how they should grow. Apex bodies in India should be working on the formulation, coordination and promotion of standard guidelines, which will help in formulating a cross culturally accepted growth chart simple enough for community level health workers to understand and use for addressing the pattern of growth for both LBW as well as normal weight babies. This might help in reduction of the magnitude of NCDs in India as well as in the world in the future.[14]

 
   References Top

1.Kay's SK, Hindmarsh PC. Catch-up growth: An overview. Pediatr Endocrinol Rev 2006;3:365-78.  Back to cited text no. 1
    
2.Hales CN, Barker DJ. The thrifty phenotype hypothesis. Br Med Bull 2001;60:5-20.  Back to cited text no. 2
    
3.Neel JV. The "thrifty genotype" in 1998. Nutr Rev 1999;57:S2-9.  Back to cited text no. 3
[PUBMED]    
4.Gluckman PD, Hanson MA. The developmental origins of the metabolic syndrome. Trends Endocrinol Metab 2004;15:183-7.  Back to cited text no. 4
    
5.Bateson P, Barker D, Clutton-Brock T, Deb D, D'Udine B, Foley RA, et al. Developmental plasticity and human health. Nature 2004;430:419-21.  Back to cited text no. 5
    
6.Eriksson JG, Forsén T, Tuomilehto J, Osmond C, Barker DJ. Early growth and coronary heart disease in later life: Longitudinal study. BMJ 2001;322:949-53.  Back to cited text no. 6
    
7.Eriksson JG, Forsén T, Tuomilehto J, Winter PD, Osmond C, Barker DJ. Catch-up growth in childhood and death from coronary heart disease: Longitudinal study. BMJ 1999;318:427-31.  Back to cited text no. 7
    
8.Harada K, Torii S, Saruwatari A, Tanaka Y, Kitaoka K, Takaaki J, et al. Association between low birth weight and high adult waist-to-height ratio in non-obese women: A cross-sectional study in a Japanese population. Tohoku J Exp Med 2012;228:205-14.  Back to cited text no. 8
    
9.Fall CH, Pandit AN, Law CM, Yajnik CS, Clark PM, Breier B, et al. Size at birth and plasma insulin-like growth factor-1 concentrations. Arch Dis Child 1995;73:287-93.  Back to cited text no. 9
    
10.Stein CE, Fall CH, Kumaran K, Osmond C, Cox V, Barker DJ. Fetal growth and coronary heart disease in south India. Lancet 1996;348:1269-73.  Back to cited text no. 10
    
11.Bavdekar A, Yajnik CS, Fall CH, Bapat S, Pandit AN, Deshpande V, et al. Insulin resistance syndrome in 8-year-old Indian children: Small at birth, big at 8 years, or both? Diabetes 1999;48:2422-9.  Back to cited text no. 11
    
12.Joglekar CV, Fall CH, Deshpande VU, Joshi N, Bhalerao A, Solat V, et al. Newborn size, infant and childhood growth, and body composition and cardiovascular disease risk factors at the age of 6 years: The Pune Maternal Nutrition Study. Int J Obes (Lond) 2007;31:1534-44.  Back to cited text no. 12
    
13.Brown N, Sasidharan CK, Fisher D. Early growth and markers of cardiovascular risk in Keralan children in the integrated child development scheme. Public Health Nutr 2010;13:1042-8.  Back to cited text no. 13
    
14.Krishnaveni GV, Veena SR, Wills AK, Hill JC, Karat SC, Fall CH. Adiposity, insulin resistance and cardiovascular risk factors in 9-10-year-old Indian children: Relationships with birth size and postnatal growth. J Dev Orig Health Dis 2010;1:403-11.  Back to cited text no. 14
    



 
 
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