Abstract
Background: Childhood growth stunting is negatively associated with cognitive and health outcomes, and is claimed to be irreversible after age 2.Aim: To estimate growth rates for children aged 2–7 who were stunted (sex-age standardised z-score [HAZ] <−2), marginally-stunted (−2 ≤ HAZ ≤−1) or not-stunted (HAZ >−1) at baseline and tracked annually until age 11; frequency of movement among height categories; and variation in height predicted by early childhood height.Subjects and methods: This study used a 9-year annual panel (2002–2010) from a native Amazonian society of horticulturalists–foragers (Tsimane’; n = 174 girls; 179 boys at baseline). Descriptive statistics and random-effect regressions were used.Results: This study found some evidence of catch-up growth in HAZ, but persistent height deficits. Children stunted at baseline improved 1 HAZ unit by age 11 and had higher annual growth rates than non-stunted children. Marginally-stunted boys had a 0.1 HAZ units higher annual growth rate than non-stunted boys. Despite some catch up, ∼ 80% of marginally-stunted children at baseline remained marginally-stunted by age 11. The height deficit increased from age 2 to 11. Modest year-to-year movement was found between height categories.Conclusions: The prevalence of growth faltering among the Tsimane’ has declined, but hurdles still substantially lock children into height categories.
Highlights
We found some evidence of catch-up growth in HAZ but persistent height deficits
We focus on three sets of estimates: (1) growth rates of children 2 ≤ age ≤ 7 who were stunted (HAZ < −2), marginally-stunted (−2 ≤ HAZ ≤ −1), or not-stunted (HAZ > −1) at baseline (2002) and who were tracked annually until they reached age 11 or until the panel ended (2010); (2) the frequency of movement among the three height categories; and (3) whether stunting at age 2 is predictive of subsequent short height at age 11
During ages 2 through 11, are children once stunted always stunted, once not-stunted always not-stunted, or do they move among height categories in the long-term? Through the third set of estimates we explore if children at the eve of puberty are locked into their early childhood height and assess the room for public policies to redress growth faltering
Summary
Childhood growth stunting is a public-health concern because in high-prevalence developing countries it is associated with higher mortality for children < age 5 years, lower educational attainment, and worse physical health, cognitive skills, and socioeconomic outcomes throughout life and, in some cases, across generations (Berkman et al 2002, Crookston, et al 2013, Dewey and Begum, 2011, Hoddinott et al, 2008, Hoddinott et al, 2013, Prendergast and Humphrey, 2014, Schott et al, 2013, Schwinger et al, 2016, Victora et al, 2008). Stunting is thought by some to be irreversible after age 2 (see review in Crookston et al (2013)), but some evidence suggests that it is reversible with improved living conditions or with public health interventions (Adair, 1999, Lundeen et al, 2014a, Prentice et al, 2013, Schott et al, 2013) These analyses have raised the question of how to best assess catch-up growth in height based on longitudinal analyses (Cameron et al, 2005, Georgiadis et al, 2016, Leroy et al, 2015, Victora et al, 2014). Childhood growth stunting is negatively associated with cognitive and health outcomes, claimed to be irreversible after age 2
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