Nutritional and Social Determinants of Growth Velocity among Rural Under-Five Children: A Longitudinal Pathway Analysis

Background: Growth velocity reflects dynamic child growth and may provide earlier evidence of growth faltering than static anthropometric indicators. The objective was to examine nutritional and social determinants of growth velocity and explore direct and indirect pathways among rural under-five children. Methods: A community-based longitudinal study was conducted among 270 children aged 1-4 years in rural Belagavi, India. Children were followed monthly for 12 months. Growth velocity (cm/month) was derived from serial height measurements. Socio-demographic, birth, feeding, and dietary factors were assessed. Multivariable linear regression identified determinants of growth velocity. Direct and indirect effects were estimated using product-of-coefficients mediation analysis with bootstrapped confidence intervals. Results: Birth weight differed across growth-velocity tertiles (p=0.006). Continued breastfeeding was independently associated with higher growth velocity (adjusted β=0.059 cm/month; 95% CI: 0.012-0.106; p=0.014). Birth order ≥2 showed a borderline inverse association (adjusted β=-0.048; 95% CI: -0.096 to 0.000; p=0.051). Other social, parental, and dietary variables were not independently associated with growth velocity. Birth order demonstrated a small indirect effect through continued breastfeeding (indirect β=0.006; 95% CI: 0.001-0.012). Conclusions: Continued breastfeeding showed the strongest association with growth velocity, whereas social and parental characteristics demonstrated limited direct and modest indirect associations.