Weight-for-Height, Body Fat, and Development in Children in the East Asia and Pacific Region

Key Points

Question

What is the combined association of weight-for-height z score and body fat with early development in the East Asia and Pacific region?

Findings

This cross-sectional study of 6815 children found that compared with children with normal weight and normal body fat, children with low body fat, either with wasting or normal weight, were more likely to have poor total, cognitive, language, and socioemotional development independent of confounding factors.

Meaning

These findings reinforce the potential to use body fat, in addition to weight-for-height z score, to identify children who are not on track developmentally.

Abstract

This cross-sectional study examines the combined association of weight-for-height z score and body fat with early childhood development in the East Asia and Pacific region.

Abstract

Importance

Weight-for-height z score (WHZ) is a standard indicator of children’s nutritional status even though it does not fully reflect body fat.

Objective

To examine the combined association of WHZ and body fat with early development in the East Asia and Pacific region.

Design, Setting, and Participants

Children from the East Asia–Pacific Early Child Development Scales validation study, with full data available regarding their nutritional status and outcomes, were included in this cross-sectional analysis. In brief, a multilevel stratified random sampling was used to select representative samples from each participating country in the study. WHZ and body fat were independently trichotomized using established references and were combined to form a 9-category exposure variable. Data collection was performed between 2012 and 2014, and the analyses were conducted in June 2021.

Main Outcomes and Measures

The binary outcome variable of not being developmentally on track (hereafter referred to as poor development) was defined as a score less than the 25th percentile in the following domains: cognitive, language, socioemotional, motor development, and total development score. Poisson regression models were used to analyze the associations between the combined categories and poor development, adjusted for sociodemographic factors.

Results

A total of 6815 children (mean [SD] age, 4.02 [0.8] years; 3434 girls [50.4%]) had full data available and were included in this study. Compared with children with normal weight and normal fat, those with wasting and low body fat had the highest likelihood of total poor development (prevalence ratio, 1.47; 95% CI, 1.28-1.70), followed by those with normal weight but low fat (prevalence ratio, 1.23; 95% CI, 1.11-1.36). Similar associations were found in language, cognitive, and socioemotional development, but not in motor development.

Conclusions and Relevance

Poor development was more commonly found in children with low body fat independent of WHZ (wasted or normal weight). Early public health strategies may consider using a combination of WHZ and body fat as an indicator of poor development.