Child Growth Curves in High-Altitude Ladakh: Results from a Cohort Study.

Wen-Chien Yang,Kuen-Cheh Yang,Chun-Min Fu,Chung-Mei Ouyang,Bo-Wei Su

doi:10.3390/ijerph17103652

Abstract

High prevalence of child underweight and stunting in high-altitude areas has often been reported. However, most previous studies on this topic were cross-sectional. Another critical concern is that using the World Health Organization (WHO) Child Growth Standards to evaluate child growth in high-altitude areas may lead to overestimations of underweight and stunting. Our study aimed to evaluate the long-term growth pattern of children (3 to 18 years) above the altitude of 3500 m in Ladakh, India. The participants’ body weight (BW), body height (BH), and body mass index (BMI) were measured annually according to the WHO Child Growth Standards for children under 5 years old and the WHO reference data for children aged 5 to 19 years. The generalized estimating equation (GEE) was used to estimate the means and z-scores of BW, BH, and BMI at different ages. A total of 401 children were enrolled from 2012 to 2018. Their mean z-scores of BW, BH, and BMI were −1.47, −1.44, and −0.85 in 2012 and increased to −0.74, −0.92, and −0.63 in 2018. This population’s specific growth curve was also depicted, which generally fell below the 85th percentile of the WHO standards. This is the first cohort study about long-term child growth patterns in a high-altitude area. The detailed underlying mechanisms of our findings need future research on more representative data of high-altitude populations.

Highlights

Living in high-altitude areas affects child health through various mechanisms
During the period from 2012 to 2018, there were 401 children and adolescents aged 3 to 18 years enrolled in this study, including 206 boys (51.4%) and 195 girls (48.6%)
New students entered this cohort annually; some might have left due to personal reasons, and some graduated in 2018

Summary

Introduction

Living in high-altitude areas affects child health through various mechanisms. Low-oxygen environments, scarceness of resources, and lack of health infrastructure are common risk factors of poor health and restricted growth [1]. Children are more likely to have respiratory infectious diseases, poor nutritious condition, and growth retardation [2,3]. Some of these risk factors are inherently associated. There is no single leading risk factor, the impact of living in high-altitude areas on child health is certain. High prevalence of child underweight and stunting in high-altitude areas has often been reported [4,5,6,7,8,9,10,11,12,13,14,15]. Children from Peruvian Quechua [7,8], Bolivian Aymara [9,10], and Tibet were generally shorter and lighter than their low-altitudinal counterparts of the same ethnicities [5,6,11,12]

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Methods

Results

Discussion

Conclusion