Early childhood growth patterns and malnutrition in rural Southern India: a longitudinal study of a birth cohort

Background Malnutrition remains a pervasive problem among Indian children, but cross-sectional surveillance surveys and studies fail to identify secular trends and growth patterns. The study analyzed longitudinal data from the Longitudinal Indian Family hEalth (LIFE) birth cohort, established in 2009 to examine early childhood development. The field area for the LIFE cohort consists of rural to peri-urban villages in Medchal-Malkajgiri district, Telangana State, India, located approximately 40 km from Hyderabad, Telangana, India. This setting features predominantly agrarian households with socioeconomic challenges. Growth and malnurtition patterns in normal-birth-weight (NBW) and low-birth-weight (LBW) children were compared at multiple time points. Methods Five hundred and forty children were included. Trained staff recorded height/weight via standardized methods every six months (± two months) until 24 months, then yearly until 60 months. Anthropometric indices were stunting (HAZ < −2 SD), wasting (WHZ < −2 SD), and underweight (WAZ < −2 SD). Group differences were analyzed using proportion tests and unpaired t -tests to compare growth patterns between LBW and NBW, and to assess sex-based differences between boys and girls, following normality checks. Survival curves depicted trends and LBW vs. NBW differences were tested via Log-rank test. Results WAZ, HAZ, and WHZ distributions remained below WHO reference curves throughout 6–60 months. Mean WAZ declined by 0.75 (NBW) and 0.40 (LBW); HAZ improved by 0.79 and 1.51, respectively. LBW-NBW differences in WAZ and HAZ narrowed rapidly after 3 and 2 years. Underweight prevalence rose from 18.8% (6 months) to 37.0% (36 months), stabilizing thereafter. Kaplan-Meier analysis showed 96% LBW vs. 87% NBW stunted, and 81% vs. 62% underweight by 60 months (steepest declines in first 18 months). Conclusion Malnutrition significantly affects rural Southern India children, especially in the first three years, with LBW children and girls most at risk. LBW children demonstrated persistent acute and chronic malnutrition patterns until three years, after which the gradient between LBW and NBW reduced but never equalized, indicating the need for tailored nutritional supplementation.