Catch-up growth occurs after diarrhea in early childhood

Stephanie A. Richard, Robert E. Black, Robert H. Gilman, Richard L. Guerrant, Gagandeep Kang, Claudio F. Lanata, Kare Mølbak, Zeba A. Rasmussen, R. Bradley Sack, Palle Valentiner-Branth, William Checkley*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Diarrhea and linear growth faltering continue to burden low-income countries and are among the most important contributors to poor health during early childhood. Diarrhea is thought to adversely affect linear growth, but catch-up growth can occur if no additional insults are experienced. We sought to characterize catch-up growth in relation to diarrhea burden in a multisite dataset of 1007 children. Using longitudinal anthropometry and diarrheal surveillance data from 7 cohort studies in 4 countries, we examined the relation between diarrhea prevalence and growth in 3- to 6-mo periods using linear mixed-effect models. Growth during each period was calculated as a function of age using linear splines. We incorporated the longitudinal prevalence of diarrhea in both current and previous periods into the model. Diarrhea during the current periodwas associated with slower linear and ponderal growth. Faster (catch-up) growth in length was observed in children with no diarrhea in age groups immediately after an age group in which diarrhea was experienced [age group >6-12 mo: 0.03 mm/mo for each percentage diarrhea prevalence in the previous period (95% CI: 0.007, 0.06) relative to 11.3 mm/mo mean growth rate; age group >12-18 mo: 0.04 mm/mo (95% CI: 0.02, 0.06) relative to 8.9 mm/mo mean growth rate; age group >18-24 mo: 0.04mm/mo (95%CI: 0.003, 0.09) relative to 7.9mm/momean growth rate]. The associations were stronger in boys than in girlswhen separate modelswere run. Similar results were observed whenweightwas the outcome variable.When diarrheal episodes are followed by diarrhea-free periods in the first 2 y of life, catch-up growth is observed that may allow children to regain their original trajectories. The finding of a greater effect of diarrhea on linear growth in boys than in girls was unexpected and requires additional study. Diarrhea burdens are high throughout the first 2 y of life in these study sites, therefore reducing the likelihood of catch-up growth. Extending diarrhea-free periods may increase the likelihood of catch-up growth and decrease the prevalence of stunting.

Original languageEnglish
Pages (from-to)965-971
Number of pages7
JournalJournal of Nutrition
Issue number6
StatePublished - Jun 2014
Externally publishedYes


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