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

Seyram Kaali, Darby W. Jack, Rebecca K.D. Prah, Steven N. Chillrud, Mohammed N. Mujtaba, Patrick L. Kinney, Theresa Tawiah, Qiang Yang, Felix B. Oppong, Carlos F. Gould, Musah Osei, Blair J. Wylie, Oscar Agyei, Matthew S. Perzanowski, Kwaku Poku Asante, Alison G. Lee

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2136-2146
Number of pages11
JournalPediatric Pulmonology
Issue number9
StatePublished - Sep 2022


  • growth
  • impulse oscillometry
  • low- and middle-income country
  • stunting


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