As per guidelines, anthropometric measurements were conducted using calibrated instruments (Ministry of Health, 2008 ). Height (±0.1 cm) was measured using a portable stadiometer (Leicester Height Measure or SECA 214) and weight (±0.1 kg) was measured using a floor scale (SECA 862, SECA 770, Tanita WB 100 S MA or Tanita HD-351). The WHO Anthro Macro (version 3.2.2) was used to obtain sex-specific body mass index (BMI)-for-age Z-scores (WHO Anthro Department of Nutrition, 2019 ). A three-level categorical variable, BMI, was used to indicate children within a healthy BMI range of plus or minus one standard deviation (SD) of the WHO mean for children at 4 years of age, those one SD below the mean considered underweight, and one SD above the mean considered overweight (de Onis et al., 2019 (link)).