Correction to: Exposure to improved nutrition from conception to age 2 years and adult cardiometabolic disease risk: misclassification of 31 individuals
Authors: Nicole D Ford, Jere R Behrman, John F Hoddinott, John A Maluccio, Reynaldo Martorell, Manuel Ramirez-Zea, Aryeh D Stein
Journal: The Lancet Global Health (2019)

The Institute of Nutrition of Central America and Panama (INCAP) cohort participated in a nutrition intervention as children from 1969 to 1977 in Guatemala and has been followed up prospectively to assess the effect of improved nutrition on a range of growth, health, and development outcomes. We reported previously that exposure to improved protein-energy nutrition from conception to the second birthday was associated with reduced odds of diabetes and increased risk of obesity and several obesity-related conditions.1Ford ND Behrman JR Hoddinott JF et al.Exposure to improved nutrition from conception to age 2 years and adult cardiometabolic disease risk: a modelling study.Lancet Glob Health. 2018; 6: e875-e884Google Scholar We identified an error in the analytic data set, and hence in the estimates presented in the 2018 paper.1Ford ND Behrman JR Hoddinott JF et al.Exposure to improved nutrition from conception to age 2 years and adult cardiometabolic disease risk: a modelling study.Lancet Glob Health. 2018; 6: e875-e884Google Scholar As a result of a file-merge routine, the date of birth (which was used to define the window of exposure to the intervention) was erroneously set to “missing” for 167 individuals. All these individuals were classified as unexposed to the intervention in a subsequent coding step. Among these 167 individuals, 31 individuals should have been considered exposed. Additionally, two individuals were incorrectly classified on the basis of pregnancy or lactation status. To correct this mistake, we included one man who had been wrongfully excluded and removed one woman with unknown pregnancy status.After correctly classifying these 33 individuals, the primary inference that protein-energy supplementation increased risk of obesity (OR 1·99, 95% CI 1·16 to 3·41) and reduced risk of diabetes (OR 0·47, 95% CI 0·22 to 0·99) was unaltered. Exposure to improved nutrition from conception to the second birthday was no longer significantly associated with total cholesterol, non-HDL cholesterol, or diastolic blood pressure. We found stratum heterogeneity (at p<0·05) by sex in pooled models for body-mass index (1·06 kg/m2, 95% CI −0·60 to 2·71, for women vs 1·56 kg/m2, 0·07 to 3·05, for men), waist circumference (1·54 cm, 95% CI −2·31 to 5·40, for women vs 4·38 cm, 0·61 to 8·15, for men), waist-height ratio (0·01, −0·02 to 0·04, for women vs 0·02, 0·00 to 0·04, for men), and body fat (0·75%, −1·07 to 2·57, for women vs 2·61%, 0·18 to 5·04, for men). There is no longer evidence of stratum heterogeneity by sex in pooled models for non-HDL cholesterol and post-challenge glucose. The 2018 report and online material are appended to this letter as an appendix, with tracked changes showing the effects of correcting the misclassified participants. We declare no competing interests. Download .pdf (.52 MB) Help with pdf files Supplementary appendix Exposure to improved nutrition from conception to age 2 years and adult cardiometabolic disease risk: a modelling studyImproved protein-energy nutrition from conception to the 2nd birthday reduced the odds of diabetes at ages 37–54 years; however, this protein-energy supplementation also increased the risk of obesity and several obesity-related conditions. Our findings suggest a mixed ability of protein-energy nutritional supplementation in early life to prevent adult cardiometabolic disease incidence in the context of high childhood stunting and high adult overweight and obesity. Full-Text PDF Open AccessCorrection to Lancet Glob Health 2018; 6: e875–84Ford ND, Behrman JR, Hoddinott JF, et al. Exposure to improved nutrition from conception to age 2 years and adult cardiometabolic disease risk: a modelling study. Lancet Glob Health 2018; 6: e875–84—In this Article, an error in the analytic data set was identified, which meant that some estimates presented in the paper were incorrect. The authors have written a Correspondence explaining these errors and the data in the Article have been corrected. These corrections have been made as of Dec 12, 2019. Full-Text PDF Open Access