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

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.