Journal Article

Head Circumference Versus Length and Weight Deficits up to 2 Years of Age in Bangladesh

Mohsin, Minhazul, Keya, Farhana Khanam, Hamer, Davidson H., Roth, Daniel E., Cho, Leanna, Watson, Kelly M., Qamar, Huma, Shah, Prakesh S., Dasiewicz, Alison S. B., Mahmud, Abdullah Al, Bassani, Diego G., Zlotkin, Stanley

2025

Overview

Infant undernutrition, defined by length‐ and weight‐based indices, is common in low‐ and middle‐income countries (LMICs), but corresponding deficits in head size have received less attention. In a cohort of term newborns in Dhaka, Bangladesh, we compared the severity of deficits (vs. World Health Organization Growth Standards) in head circumference (HC), length and weight at birth and every 3 months until 2 years of age (n range across timepoints: 843–920). We estimated the mean and 25th, 50th and 75th percentiles of HC‐, length‐ and weight‐for‐age z‐scores (HCZ, LAZ and WAZ, respectively). Differences between HCZ and LAZ (or WAZ) were analyzed using paired t tests and quantile regression. We also derived HCZ using height‐age instead of chronological age at 3–24 months. Mean HCZ was significantly higher than mean LAZ and WAZ at birth, but HCZ was significantly lower than LAZ at 6, 9 and 12 months and the HCZ and LAZ deficits were similar from 15 to 24 months. Mean HCZ was lower than WAZ at all ages beyond birth. Patterns were broadly consistent at the 25th, 50th and 75th percentiles. The HCZ deficit remained evident when HC was standardized using height‐age at all ages beyond birth, indicating HC was reduced relative to body size. In conclusion, among term‐born children in Dhaka, HCs were smaller than international standards at all ages up to 2 years, and there was no evidence of postnatal head sparing. Consideration should be given to routine measurement of HC in population health surveys in LMICs. Term infants in Bangladesh had smaller head circumferences compared to international standards. In the postnatal period (3–24 months of age), average deficits in head circumference were more severe than expected based on body lengths, indicating a lack of head‐sparing in a setting where early childhood undernutrition is widespread. Summary In a Bangladeshi cohort of term infants, average head circumference (HC) z‐scores were closer to international norms than corresponding length and weight z‐scores at birth, suggesting possible foetal head sparing. Postnatal head sparing was not observed among children in Dhaka at any timepoint following birth. At 6, 9 and 12 months of age, the HC distribution was further below the international norm compared to the length and weight distributions. Analyses using height‐age rather than chronological age showed that postnatal HC deficits were more severe than expected given children's average height, at all timepoints following birth. The entire HC distribution was negatively displaced relative to the international standard at all ages, indicating that the head size deficit is a whole‐population condition, analogous to linear growth faltering. HC, like length and weight, should be considered for routine monitoring in LMIC settings where early childhood undernutrition is common.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Age / Age differences / Anthropometry / Bangladesh - epidemiology / Body Height / Body size / Body Weight / Cephalometry / Child Development / Child, Preschool / Childbirth & labor / Childrens health / Cohort Studies / crown‐rump length / developing countries / Female / growth and development / Head - anatomy & histology / Head - growth & development / Health surveys / Humans / Infant / Infant, Newborn / Infants / International standards / Low income groups / Male / Malnutrition / Measurement / Newborn babies / Original / Postpartum period / Public health / Regular