ESPE Yearbook of Paediatric Endocrinology

JAMA Netw Open. 2025 Jun 2;8(6):e2514289. PMID: 40478571 doi: 10.1001/jamanetworkopen.2025.14289

Brief Summary: This prospective cohort study in Mali evaluated the potential risks and benefits of weight gain in children with undernutrition. A 1 SD increase in weight between ages 1 to 10 years was associated with taller stature, but not with an increased risk of obesity or hypertension.

In low- and middle-income countries (LMICs), concern has been raised about the influence of rapid relative weight gain in children over 2 years of age on development of obesity and/or hypertension in adulthood. However, persistent undernutrition can affect longitudinal growth and adult height as well as result in increased morbidity and mortality. The authors analysed data from the Dogon Longitudinal Study, a 21-year population-based multigenerational cohort study conducted in Mali from 1998 to 2019. This cohort included 1348 individuals aged 5 years or younger in April 1998 and all children born after that date until July 2000 with multiple measurements of weight, height and systolic blood pressure (SBP).

Using mediation analysis, the authors quantified the direct and indirect associations between childhood weight and adult SBP at 21 years of age. Adjustments were made for the height and SBP of both parents to reduce genetic confounding. Children who showed a 1SD weight increase over the first decade of childhood were taller: mean height increased by 3.0 cm in girls and 4.1 cm in boys. They also had higher BMI and SBP at 21 years, but none of these children became obese and few became hypertensive in adulthood.

This study illustrates the potential advantages of improved weight gain to increase longitudinal growth in this setting, and the need for public health policy in LMICs to improve childhood nutrition.