Socioeconomic variation in height: analysis of National Child Measurement Programme data for England

Short stature and language development in the United Kingdom: a longitudinal analysis of children from the Millennium Cohort Study

BACKGROUND

In low- and middle-income countries, poverty and impaired growth prevent children from meeting their cognitive developmental potential. There are few studies investigating these relationships in high-income settings.

METHODS

Participants were 12,536 children born between 2000 and 2002 in the UK and participating in the Millennium Cohort Study (MCS). Short stature was defined as having a height-for-age 2 or more standard deviations below the median (≤ - 2 SDS) at age 3 years. Standardized British Abilities Scales II (BAS II) language measures, used to assess language development at ages 3, 5, 7 and 11 years, were the main outcome assessed.

RESULTS

Children with short stature at age 3 years (4.1%) had language development scores that were consistently lower from ages 3 to 11 years (- 0.26 standard deviations (SD) (95% CI - 0.37, - 0.15)). This effect was attenuated but remained significant after adjustment for covariates. Trajectory analysis produced four distinct patterns of language development scores (low-declining, low-improving, average and high). Multinomial logistic regression models showed that children with short stature had a higher risk of being in the low-declining group, relative to the average group (relative risk ratio (RRR) = 2.11 (95% CI 1.51, 2.95)). They were also less likely to be in the high-scoring group (RRR = 0.65 (0.52, 0.82)). Children with short stature at age 3 years who had 'caught up' by age 5 years (height-for-age ≥ 2 SDS) did not have significantly different scores from children with persistent short stature, but had a higher probability of being in the high-performing group than children without catch-up growth (RRR = 1.84 (1.11, 3.07)).

CONCLUSIONS

Short stature at age 3 years was associated with lower language development scores at ages 3 to 11 years in UK children. These associations remained significant after adjustment for socioeconomic, child and parental factors.

The effect of different socio-economic and working conditions on body size and proportions: A case study on adults from Samsun, Turkey

Conditions in the early stages of life shape body size and proportions. This study includes individuals who came from different socio-economic conditions and worked in physically demanding jobs in childhood. By determining the body sizes of these individuals and evaluating the proportional relationships between several groups, the goal was to understand the effect levels of socio-economic levels and working conditions on the body. For this purpose, an anthropometric study was conducted on 623 males and females between the ages of 20 and 45 living in Samsun, Turkey. The study sample consisted of four different groups. It was divided into two main groups of high and low socio-economic level, and the low socio-economic group was divided into two subgroups of heavy-worker and nonheavy-worker. The results demonstrated that socio-economic differences in the size and proportions of the individuals were statistically significant (p<0.05). The high socio-economic group had the highest values in all measures. External factors affected the lower limbs more than the upper limbs. The measurement most affected by these factors was leg length. Longer legs characterized the high socio-economic group, while longer arms characterized both low socio-economic groups. The relative differences observed can be said to derive from the distal limbs. This finding was valid for both sexes. The average values were close to each other in the low socio-economic group, for which the aim was to comprehend the effects of heavy working conditions. However, differences in proportional relationships were more significant. In this context, it was seen that heavy labour also affected growth, in addition to the well-known factors encountered during the growth period, such as nutrition, health, and illness. The observed changes were more significant in males than in females. Thus, it can be said that males were more affected by physiological and physical conditions.

Evaluating the sensitivity and specificity of the UK and Dutch growth referral criteria in predicting the diagnosis of pathological short stature

OBJECTIVE

The aim of this observational study was to evaluate the UK and Dutch referral criteria for short stature to determine their sensitivity and specificity in predicting pathological short stature. Adherence to the recommended panel of investigations was also assessed.

STUDY DESIGN

Retrospective review of medical records to examine the auxological parameters, investigations and diagnosis of subjects referred to two paediatric endocrine clinics at the Royal London Children's Hospital between 2016 and 2021. We analysed: height SD score (HtSDS), height SDS minus target height SDS (Ht-THSDS) and height deflection SDS (HtDefSDS). The UK referral criteria were HtSDS <-2.7, Ht-THSDS >2.0 and HtDefSDS >1.3. The Dutch referral criteria were HtSDS <-2.0, Ht-THSDS >1.6 and HtDefSDS >1.0.

RESULTS

Data were available for 143 subjects (72% males) with mean (range) age 8.7 years (0.5-19.9). HtSDS and Ht-THSDS were significantly lower in the pathological stature (n=66) versus the non-pathological stature (n=77) subjects (-2.67±0.82 vs -1.97±0.70; p<0.001 and -2.07±1.02 vs -1.06±0.99; p<0.001, respectively). The sensitivity and specificity to detect pathology was 41% and 83% for the UK criteria (HtSDS <-2.7) compared with 59% and 79% for the Dutch criteria (HtSDS <-2.0), 48% and 83% for UK criteria (Ht-THSDS <-2.0) compared with 74% and 72% for Dutch criteria (Ht-THSDS <-1.6) and 33% and 68% for UK criteria (HtDefSDS >1.3) compared with 44% and 63% for the Dutch criteria (HtDefSDS >1.0). On average, each patient had 88% of the recommended investigations, and 53% had all the recommended testing. New pathology was identified in 36% of subjects.

CONCLUSIONS

In isolation, the UK auxological referral thresholds have limited sensitivity and specificity for pathological short stature. The combination of HtSDS and Ht-THSDS improved the sensitivity of UK criteria to detect pathology from 41% to 68%. Attention to the child's genetic height potential prior to referral can prevent unnecessary assessments.

Somatotypological features of men of working age – natives of the North

Anthropometry is known as the basic method for the body physical status assessment.

The aim. The study examined anthropometric and somatometric indices in the working age men and investigated physical development variables specific for the region in terms of being used for early diagnosing obesity-related risks for non-infectious diseases.

Materials and methods. One hundred and twenty-three male subjects aged 32–40 participated in the survey (mean age was 35.2 ± 0.2 years). Subjective main physical

development parameters were analyzed.

Results. Participants’ average body length variables were seen to be significantly higher than those in other Russia’s regions and some other countries. The similar tendency was observed for subjective body mass, chest circumference, and body mass index variables with disharmonic somatotype and hypersthenic type of body constitution revealed in examined working age men in comparison with younger male subjects. Musculoskeletal mass loss and fat accumulation indicate the development tendency of sarcopenia in men of working age. Excessive body weight prevalence in 32–40-year-old men was 47 %, and 17 % of the examinees were diagnosed with 1st degree obesity.

Conclusion. The survey identified the modern population of male northerners as having negative tendencies in their somatometric picture, which involves disharmonic somatotype, sarcopenia, excessive body weight, and 1st degree obesity and results in significant risks for non-infectious inflammation and cardiovascular diseases at the studied age.

Analysis of risk factors and construction of a prediction model for short stature in children

BACKGROUND

Short stature in children is an important global health issue. This study aimed to analyze the risk factors associated with short stature and to construct a clinical prediction model and risk classification system for short stature.

METHODS

This cross-sectional study included 12,504 children aged 6-14 years of age from 13 primary and secondary schools in Pingshan District, Shenzhen. A physical examination was performed to measure the height and weight of the children. Questionnaires were used to obtain information about children and their parents, including sex, age, family environment, social environment, maternal conditions during pregnancy, birth and feeding, and lifestyle. The age confounding variable was adjusted through a 1 : 1 propensity score matching (PSM) analysis and 1,076 children were selected for risk factor analysis.

RESULTS

The prevalence of short stature in children aged 6-14 years was 4.3% in the Pingshan District, Shenzhen. The multivariate logistic regression model showed that the influencing factors for short stature were father's height, mother's height, annual family income, father's level of education and parents' concern for their children's height in the future (P < 0.05). Based on the short stature multivariate logistic regression model, a short stature nomogram prediction model was constructed. The area under the ROC curve (AUC) was 0.748, indicating a good degree of discrimination of the nomogram. According to the calibration curve, the Hosmer-Lemesio test value was 0.917, and the model was considered to be accurate. Based on a risk classification system derived from the nomogram prediction model, the total score of the nomogram was 127.5, which is considered the cutoff point to divides all children into low-risk and high-risk groups.

CONCLUSION

This study analyzed the risk factors for short stature in children and constructed a nomogram prediction model and a risk classification system based on these risk factors, as well as providing short stature screening and assessment individually.

Prevalence of Childhood Short Stature, Underweight, Overweight, and Obesity Among Primary School Children

Background This study, the first of its kind in Morocco, was conducted to compare the prevalence of growth disorders among children enrolled in public, private, urban, and rural schools in Oujda-Angad Province. Methods A cross-sectional observational study was conducted among primary schools in Oujda-Angad Province from November 2017 to April 2018, with a stratified random cluster sampling of public, private, urban, and rural primary schools. Results A representative sample of 1582 students aged from five to 15 years old was selected. The sample included 779 females (49.2%) and 803 males (50.8%), with an average age of 9.3 ± 1.96 years. The average weight of the students was 29.3 ± 9.6 kg (range: 12-130 kg), the average height was 133.7 ± 12.16 cm (range: 104.5-175.5 cm), and the mean body mass index (BMI) was 16.05 ± 3.31 kg/m² (range: 8.33-76.9 kg/m²). Overall, short stature (SS) and underweight were significantly more prevalent in the public and rural schools, while obesity was highest in the urban private schools that ranked as the schools with the highest socioeconomic status (SES) students (p < 0.01). Female students were more likely to be overweight and obese, while male students were more likely to be underweight. Conclusion Our study provides an estimate of the prevalence of excess weight, underweight, and short stature in a primary school population. Our results reflect the importance of the problem, the need to monitor the nutritional status at both the individual and the community level, and the need to put in place preventive, diagnostic, and early management strategies before the problem worsens.

Regional differences in short stature in England between 2006 and 2019: A cross-sectional analysis from the National Child Measurement Programme

BACKGROUND

Short stature, defined as height for age more than 2 standard deviations (SDs) below the population median, is an important indicator of child health. Short stature (often termed stunting) has been widely researched in low- and middle-income countries (LMICs), but less is known about the extent and burden in high-income settings. We aimed to map the prevalence of short stature in children aged 4-5 years in England between 2006 and 2019.

METHODS AND FINDINGS

We used data from the National Child Measurement Programme (NCMP) for the school years 2006-2007 to 2018-2019. All children attending state-maintained primary schools in England are invited to participate in the NCMP, and heights from a total of 7,062,071 children aged 4-5 years were analysed. We assessed short stature, defined as a height-for-age standard deviation score (SDS) below -2 using the United Kingdom WHO references, by sex, index of multiple deprivation (IMD), ethnicity, and region. Geographic clustering of short stature was analysed using spatial analysis in SaTScan. The prevalence of short stature in England was 1.93% (95% confidence interval (CI) 1.92-1.94). Ethnicity adjusted spatial analyses showed geographic heterogeneity of short stature, with high prevalence clusters more likely in the North and Midlands, leading to 4-fold variation between local authorities (LAs) with highest and lowest prevalence of short stature. Short stature was linearly associated with IMD, with almost 2-fold higher prevalence in the most compared with least deprived decile (2.56% (2.53-2.59) vs. 1.38% (1.35-1.41)). There was ethnic heterogeneity: Short stature prevalence was lowest in Black children (0.64% (0.61-0.67)) and highest in Indian children (2.52% (2.45-2.60)) and children in other ethnic categories (2.57% (2.51-2.64)). Girls were more likely to have short stature than boys (2.09% (2.07-2.10) vs. 1.77% (1.76-1.78), respectively). Short stature prevalence declined over time, from 2.03% (2.01-2.05) in 2006-2010 to 1.82% (1.80-1.84) in 2016-2019. Short stature declined at all levels of area deprivation, with faster declines in more deprived areas, but disparities by IMD quintile were persistent. This study was conducted cross-sectionally at an area level, and, therefore, we cannot make any inferences about the individual causes of short stature.

CONCLUSIONS

In this study, we observed a clear social gradient and striking regional variation in short stature across England, including a North-South divide. These findings provide impetus for further investigation into potential socioeconomic influences on height and the factors underlying regional variation.

Secular trend and social variation in height of Polish schoolchildren between 1966 and 2012

AIM

To assess secular trend and changes in social inequalities of children's height across nearly 50 years, when vast socio-political changes took place in Poland.

METHODS

Data on schoolchildren aged 7-18 years were collected in 1966, 1978, 1988 and 2012 in Poland. Height was standardised for age using the LMS method. Socio-economic status (SES) was based on 4 factors: urbanisation level, mother's and father's education, and family size (number of children). Statistics included 2-way ANOVA with post hoc Tukey's test and effect size calculations.

RESULTS

Positive secular trend in height was observed across all years. All analysed SES factors had significant effect on height which differed depending on SES category and year of Survey. Differences in height between extreme categories of SES factors decreased gradually, starting from 1978. However, only general SES in girls and urbanisation level in both sexes became insignificant in 2012.

CONCLUSION

Improvement of living conditions across nearly 50 years was reflected in the secular trend in children's height. Despite this improvement, however, the biological effects of social inequalities, visible in differences in height, to some extent, are still present in Poland.

A new Swedish reference for total and prepubertal height

Aim

We aimed to develop up‐to‐date references with standard deviation scores (SDS) for prepubertal and total height.

Methods

Longitudinal length/height measures from 1572 healthy children (51.5% boys) born at term in 1989‐1991 to non‐smoking mothers and Nordic parents were obtained from the GrowUp 1990 Gothenburg cohort. A total height SDS reference from birth to adult height was constructed from Quadratic‐Exponential‐Pubertal‐Stop (QEPS) function estimated heights based on individual growth curves. A prepubertal height SDS reference, showing growth trajectory in the absence of puberty, was constructed using the QE functions.

Results

The total height reference showed taller prepubertal mean heights (for boys 1‐2 cm; for girls 0.5‐1.0 cm) with a narrower normal within ± 2SDS range vs the GrowUp 1974 Gothenburg reference. Adult height was increased by + 0.9 cm for women (168.6 cm) and by + 1.6 cm for men (182.0 cm). Height in children growing at −2SDS (the cut‐off used for referrals) differed up to 2 cm vs the GrowUp 1974 Gothenburg reference, 3 cm vs Swedish 1981 references and World Health Organisation (WHO) 0‐5 years standard, and 6‐8 cm vs the WHO 5‐19 years reference.

Conclusion

Up‐to‐date total and prepubertal height references offer promise of improved growth monitoring compared with the references used in Sweden today.

Income inequality and social gradients in children's height: a comparison of cohort studies from five high-income countries

BACKGROUND

Health and well-being are better, on average, in countries that are more equal, but less is known about how this benefit is distributed across society. Height is a widely used, objective indicator of child health and predictor of lifelong well-being. We compared the level and slope of social gradients in children's height in high-income countries with different levels of income inequality, in order to investigate whether children growing up in all socioeconomic circumstances are healthier in more equal countries.

METHODS

We conducted a coordinated analysis of data from five cohort studies from countries selected to represent different levels of income inequality (the USA, UK, Australia, the Netherlands and Sweden). We used standardised methods to compare social gradients in children's height at age 4-6 years, by parent education status and household income. We used linear regression models and predicted height for children with the same age, sex and socioeconomic circumstances in each cohort.

RESULTS

The total analytic sample was 37 063 children aged 4-6 years. Gradients by parent education and household income varied between cohorts and outcomes. After adjusting for differences in age and sex, children in more equal countries (Sweden, the Netherlands) were taller at all levels of parent education and household income than children in less equal countries (USA, UK and Australia), with the greatest between-country differences among children with less educated parents and lowest household incomes.

CONCLUSIONS

The study provides preliminary evidence that children across society do better in more equal countries, with greatest benefit among children from the most disadvantaged socioeconomic groups.

Environmental and birth characteristics as predictors of short stature in early childhood

AIM

To evaluate for environmental and birth characteristic predictors of short stature in a large nationally representative sample.

METHODS

We evaluated 10 127 children from the Early Childhood Longitudinal Study-Kindergarten 2011 cohort, using univariate and multivariable linear and logistic regression to evaluate factors associated with short stature (height <3rd percentile) at kindergarten through second grade. Predictors included birthweight, preterm status, sex, parental education, parental income and race/ethnicity.

RESULTS

Lower birthweight was associated with short stature, with each decreasing kilogram having a 2.45 adjusted odds ratio (aOR; 95% confidence interval [CI] 1.81, 3.33) of short stature for term children in second grade. Preterm children (compared to term children) had an aOR of 2.23 (CI 1.32, 3.78) for short stature. Other predictors of short stature included female sex and lower parental income. African American children had a lower risk of short stature (aOR 0.34, CI 0.14, 0.82) compared to white children.

CONCLUSION

Predictors of short stature include lower birthweight, preterm status, female sex and parental income. Socio-economic disparities and race/ethnicity further influenced height. These data may assist paediatricians in considering contributors to stature outcomes by early school age.

Parental education and family income affect birthweight, early longitudinal growth and body mass index development differently

AIM

This study investigated the effects of two parental socio-economic characteristics, education and income, on growth and risk of obesity in children from birth to 8 years of age.

METHODS

Longitudinal growth data and national register-based information on socio-economic characteristics were available for 3,030 Swedish children. The development of body mass index (BMI) and height was compared in groups dichotomised by parental education and income.

RESULTS

Low parental education was associated with a higher BMI from 4 years of age, independent of income, immigrant background, maternal BMI and smoking during pregnancy. Low family income was associated with a lower birthweight, but did not independently predict BMI development. At 8 years of age, children from less educated families had a three times higher risk of obesity, independent of parental income. Children whose parents had fewer years of education but high income had significantly higher height than all other children.

CONCLUSION

Parental education protected against childhood obesity, even after adjusting for income and other important parental characteristics. Income-related differences in height, despite similar BMIs, raise questions about body composition and metabolic risk profiles. The dominant role of education underscores the value of health literacy initiatives for the parents of young children.

Early growth in children with coeliac disease: a cohort study

OBJECTIVES

We aimed to study growth during the first 2 years of life in children later diagnosed with coeliac disease compared with children without, in a time with changing epidemiology and improved diagnostics.

DESIGN

A prospective population-based pregnancy cohort study.

SETTING

The nationwide Norwegian Mother and Child Cohort Study.

PATIENTS

58 675 children born between 2000 and 2009 with prospectively collected growth data. Coeliac disease was identified through combined data from questionnaires and the Norwegian Patient Register.

MAIN OUTCOME MEASURES

The differences in height and weight at age 0, 3, 6, 8, 12, 15-18 and 24 months using internally standardised age and gender-specific z-scores. Linear regression and mixed models were used.

RESULTS

During a median follow-up of 8.6 years (range 4.6-14.2), 440 children (0.8%) were diagnosed with coeliac disease at a mean age of 4.4 years (range 1.5-8.5). Children with coeliac disease had significantly lower z-scores for height from 12 months (-0.09 standard deviation scores (SDS), 95% CI -0.18 to -0.01) and weight from 15 to 18 months of life (-0.09 SDS, 95% CI -0.18 to -0.01) compared with cohort controls. The longitudinal analysis from 0 to 24 months yielded a significant reduction in height z-score per year (-0.07 SDS, 95% CI -0.13 to -0.01) but not for weight among children with coeliac disease. Excluding children diagnosed before age 2 years gave similar results.

CONCLUSIONS

This study indicates that growth retardation in children later diagnosed with coeliac disease commonly starts at 12 months of age, and precedes clinical symptoms that usually bring the suspicion of diagnosis.

Prevalence of short stature, underweight, overweight, and obesity among school children in Jordan

Background

The prevalence of short stature (SS) and underweight in Jordan on a national level is unknown. This study aimed to investigate, on a national level, the prevalence of short stature (SS), underweight, overweight, and obesity among school aged children in Jordan.

Methods

This cross-sectional study was conducted from May 2015 to January 2016 and included 2702 subjects aged 6–17 years. Jordan was classified into 3 regions; North, Center (urban), and South (rural). Public and private schools were randomly selected from a random sample of cities from each region. The socioeconomic status of the sampling locations was assessed using several indicators including education, income, healthcare and housing conditions. For each participating subject, anthropometrics were obtained. SS, underweight, overweight and obesity were defined using Center of Disease Control’s (CDC) growth charts. Median Z-scores for each region, age and gender were calculated.

Results

The Central and Northern regions enjoyed higher socioeconomic status compared to rural Southern regions. The overall prevalence of SS, underweight, overweight, and obesity were 4.9 %, 5.7 %, 17.3 %, and 15.7 %, respectively. SS and underweight were most prevalent in the rural South, while obesity was highest in the Central region. Females were more likely to be overweight, while males were more likely to be obese. Private schools had higher prevalence of obesity and overweight than public ones.

Conclusions

Variations in height and weight among Jordanian school children might be affected by socioeconomic status.