Poor early childhood growth is associated with impaired lung function: Evidence from a Ghanaian pregnancy cohort

Objectives: Nearly 40% of African children under 5 are stunted. We leveraged the Ghana randomized air pollution and health study (GRAPHS) cohort to examine whether poorer growth was associated with worse childhood lung function. Study Design: GRAPHS measured infant weight and length at birth and 3, 6, 9,12 months, and 4 years of age. At age 4 years, n = 567 children performed impulse oscillometry. We employed multivariable linear regression to estimate associations between birth and age 4 years anthropometry and lung function. Next, we employed latent class growth analysis (LCGA) to generate growth trajectories through age 4 years. We employed linear regression to examine associations between growth trajectory assignment and lung function. Results: Birth weight and age 4 weight-for-age and height-for-age z-scores were inversely associated with airway resistance (e.g., R₅, or total airway resistance: birth weight β = −0.90 cmH2O/L/s, 95% confidence interval [CI]: −1.64, −0.16 per 1 kg increase; and R₂₀, or large airway resistance: age 4 height-for-age β = −0.40 cmH2O/L/s, 95% CI: −0.57, −0.22 per 1 unit z-score increase). Impaired growth trajectories identified through LCGA were associated with higher airway resistance, even after adjusting for age 4 body mass index. For example, children assigned to a persistently stunted trajectory had higher R₅ (β = 2.71 cmH2O/L/s, 95% CI: 1.07, 4.34) and R₂₀ (β = 1.43 cmH2O/L/s, 95% CI: 0.51, 2.36) as compared to normal. Conclusion: Children with poorer anthropometrics through to age 4 years had higher airway resistance in early childhood. These findings have implications for lifelong lung health, including pneumonia risk in childhood and reduced maximally attainable lung function in adulthood.