Abstract
To investigate changes in socio-economic inequalities in growth in height, weight, BMI and grip strength in children born during 1955-1993 in Guatemala, a period of marked socio-economic-political change. We modelled longitudinal data on height, weight, BMI and hand grip strength using Super-Imposition by Translation and Rotation (SITAR). Internal Z-scores summarising growth size, timing and intensity (peak growth velocity, e.g. cm/year) were created to investigate inequalities by socio-economic position (SEP; measured by school attended). Interactions of SEP with date of birth were investigated to capture secular changes in inequalities. Urban and peri-urban schools in the region of Guatemala City, Guatemala. Participants were 40 484 children and adolescents aged 3-19 years of Ladino and Maya ancestry (nobservations 157 067). The difference in height (SITAR size) between lowest and highest SEP decreased from -2·0 (95 % CI -2·2, -1·9) sd to -1·4 (95 % CI -1·5, -1·3) sd in males, and from -2·0 (95 % CI -2·1, -1·9) sd to -1·2 (95 % CI -1·3, -1·2) sd in females over the study period. Inequalities also reduced for weight, BMI and grip strength, due to greater secular increases in lowest-SEP groups. The puberty period was earlier and shorter in higher-SEP individuals (earlier SITAR timing and higher SITAR intensity). All SEP groups showed increases in BMI intensity over time. Inequality narrowed between the 1960s and 1990s. The lowest-SEP groups were still >1 sd shorter than the highest. Risks remain for reduced human capital and poorer population health for urban Guatemalans.
Highlights
(0·17–0·44), except for grip strength where the size and intensity correlation coefficient was higher at 0·81 (Table 3)
There is a narrowing of inequality through time, whereby by 1990 the two lowest-socio-economic position (SEP) groups have very similar height Z-scores to SEP 3
Our findings are supportive of previous work on within-population SEP differences in growth that found patterns of secular changes differ across SEP group[8]
Summary
Study design and participants We carried out a retrospective cohort study using longitudinal growth data of children who participated in the UVG Longitudinal Study of Child and Adolescent Development. A team of investigators visited seven study schools and measured all the students in attendance. The time elapsed between measurements usually ranged between 0·95 and 1·05 years[14]. Some participants were seen only twice and others between three and thirteen times. The schools were chosen based on parental SEP as measured by the school fees and parental education and occupation[15]. Upon enrolment in a school the children were automatically entered into the study and informed consent for participation was collected from their parents
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