(P03-16-26) Growth Trajectories and Cognitive Outcomes in Childhood: A Comparative Study of Malawi and the USA

Objectives: Variations in early-life growth patterns may reflect differences in metabolic programming that influence child attention and memory. We identified growth trajectories and their associations with attention and memory among infants and young children across multiple time points in diverse contexts.

Methods: Anthropometric data were collected from cohorts in Malawi (n=600) and suburban California, USA (n=101) at birth, and at 6–9, 8–12, and 11–15 mos. Sex-specific growth trajectory classes were identified using latent class trajectory modeling, an unsupervised learning approach. Trajectories were modeled separately for weight and weight-for-age z-score in both cohorts, and for length, length-for-age and weight-for-length z-scores in Malawi. In a subgroup (n=458 in Malawi; n=92 in the USA), associations between growth trajectories and cognitive outcomes were assessed with eye-tracking-based tasks. The Infant Orienting with Attention task measured visual attention (reaction time, task error); the Visual Paired Comparison task measured memory (novelty preference, peak look duration, shift rate; only in Malawi). Both tasks were administered longitudinally between 6–15 mos in both cohorts. Mixed effects models were used to evaluate the associations, adjusting for child, parental, and household characteristics.

Results: Growth trajectory classes varied by cohort, some aligning with WHO standards and others showing either acceleration or deceleration. In Malawi, boys who started with the lowest intercept at birth and ended with the highest weight by 12 mos demonstrated poorer memory (via novelty preference) at later ages (12–15 mos) compared with those who had a higher starting point at birth but ended in the lowest (ß ± SE: -0.13 ± 0.05; p=0.026) and average (-0.14 ± 0.05; p=0.016) trajectory classes. Associations with reaction time and shift rate were identified in Malawi at earlier ages (6–9 mos). No significant associations were observed for the USA cohort.

Conclusions: Early growth patterns are linked to emerging attention and memory, highlighting the importance of longitudinal evaluation. Further studies are warranted on pathways linking nutrition, growth, and development prenatally through six months of life.

Funding Sources: Bill & Melinda Gates Foundation, Mongolia Mengniu Dairy (Group) Company Ltd, Indonesia Endowment Fund for Education