Determinants of nutritional status during the first 1000 days of life in Lebanon: Sex of the child matters

Abstract

Background: The first 1000 days of life support child growth and long-term health, but few studies address this period in Lebanon and the Eastern Mediterranean Region. Objective: To examine the determinants of nutritional status among Lebanese children ≤2 years old by child's sex. Methods: We analysed data from a nationally representative cross-sectional survey of 466 mother-child dyads. We classified socio-economic, maternal, and child characteristics using a hierarchical conceptual framework into distal, intermediate, and proximal levels, respectively. Sex-stratified weighted multiple linear regression was computed to identify the determinants of length-for-age z-scores (LAZ) and weight-for-length z-scores (WLZ). Results: The mean (standard deviation) of LAZ and WLZ was −0.3 (1.6) and 0.5 (1.5) among boys and −0.1 (1.4) and 0.5 (1.0) among girls, respectively. At the distal level, maternal intermediate or high school education was associated with higher boys' LAZ (β 1.0, 95% confidence interval (CI) 0.2, 1.8), and less crowded households were associated with higher girls' LAZ (β 0.8, 95% CI 0.3, 1.4). At the intermediate level, maternal obesity was associated with lower girls' LAZ (β −0.9, 95% CI −1.4, −0.4). At the proximal level, birth length directly (β 0.1, 95% CI 0.0, 0.2) and breast-feeding duration inversely (β −0.1, 95% CI −0.1, −0.0) associated with girls' LAZ. For WLZ, paternal attainment of university degree or technical diploma was associated with lower boys' WLZ (β −0.9, 95% CI −1.8, −0.1). Among the proximal determinants, birthweight was directly associated with boys' WLZ (β 1.2, 95% CI 0.6, 1.8), while being a third or later child was associated with lower girls' WLZ (β −0.5, 95% CI −0.8, −0.2). Child age was directly associated with WLZ among boys and girls (β 0.1, 95% CI 0.0, 0.1). Conclusions: Nutritional status determinants differed by child's sex in Lebanon. These findings may help inform interventions to improve child growth. © 2021 John Wiley & Sons Ltd.