Geographical altitude, size, mass and body surface area in children (1–4 years) in the Province of Jujuy (Argentina)

Mapping stunted children in Ethiopia using two decades of data between 2000 and 2019. A geospatial analysis through the Bayesian approach

BACKGROUND

Childhood stunting is a major public health problem globally, resulting in poor cognition and educational performance, low adult wages, low productivity, and an increased risk of nutrition-related chronic diseases in adulthood life. Accurate and reliable data on the prevalence of stunting over time with a sub-national estimate are scarce in Ethiopia.

OBJECTIVE

Our objective was to investigate the spatiotemporal distributions and ecological level drivers of stunting among under-five children over time in Ethiopia.

METHODS

A geospatial analysis using the Bayesian framework was employed to map the spatial variations of stunting among children aged less than five years. The data for the primary outcome were obtained from the Ethiopian Demographic and Health Surveys (2000-2019) and covariates data were accessed from different publicly available credible sources. The spatial binomial regression model was fitted to identify drivers of child stunting using the Bayesian approach.

RESULT

The national prevalence of stunting was 47.9 in 2000, 43.3 in 2005, 37.3 in 2011, 36.6 in 2016, and 35.9 in 2019, with a total reduction rate of 25%. Substantial spatial clustering of stunting was observed in the Northern (Tigray), Northcentral (Amhara), and Northwestern (Amhara) parts of Ethiopia. Temperature (mean regression coefficient (β): -0.19; 95% credible interval (95% CrI): -0.25, -0.12) and population density (β: -0.012; 95% CrI: -0.016, -0.009) were negatively associated with stunting, whereas travel time to the nearest cities (β: 0.12; 95% CrI: 0.064, 0.17) was positively associated with child stunting in Ethiopia.

CONCLUSION

The prevalence of stunting varied substantially at subnational and local levels over time. Clustering of stunted children were observed in the Northern parts of Ethiopia. Temperature, population density and travel time to the nearest cities were identified as the drivers of stunting in children. Improving community awareness of child nutrition through community health extension programs should be strengthened.

Somatotype altitudinal variation and its relationship with the nutritional status of children in the Jujuy province, Argentina

OBJECTIVES

To study the somatotype variations adjusted by altitude, age, sex, and BMI categories, and to assess the health status of the children population.

METHODS

A sample of 460 children aged 8-13 years was assessed in a cross-sectional study conducted on anthropometric measurements between 2011 and 2015. Data were categorized into two age groups: Group 8-10, Group 11-13 and two altitudes: Highland (>2000 masl), lowland (<2000 masl). The somatotypic profile was determined by the Heath and Carter's study method and the Body Mass Index was used to assess children nutritional status. Generalized linear latent variable models (GLLVM) were performed to test the association between somatotype and geographic altitude. Individual age-sex specific somatotypes were plotted in a two-dimension somatochart, and group dispersion was displayed by the somatotype attitudinal mean.

RESULTS

The sample has an overall endomorph-mesomorph body type, exhibiting different patterns when altitude and sex were considered. The GLLVM showed that the whole somatotype was different by altitude. Highland children occupied central to endomorphic-mesomorphic places in the somatochart with lower variation. In both altitudes, girls exhibited higher endomorphy than boys. Several discrepancies between the BMI categorization and the somatotype were observed.

CONCLUSIONS

Jujenean children show differential body patterns across geographic altitude which exhibit age and sex variations. Children have a differential tendency to a fat mass gain. The BMI showed some inconsistencies with somatotype, leading to a misclassification of the child nutritional status, this highlights the importance of not to treat the BMI in isolation but with other determinants of the health status.

Urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old: evidence from a cross-sectional study in Tibet

OBJECTIVE

To assess urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old.

DESIGN

A three-stage, stratified, cluster sampling was used to randomly select eligible individuals from July to October 2020. The data of participants, including demographic characteristics, altitude of residence, and nutritional status, were collected via questionnaire and physical examination.

SETTING

Tibet, China.

PARTICIPANTS

Children under 5 years old in Tibet.

RESULTS

Totally, 1975 children under 5 years old were included in this study. We found that an additional 1000 m increase in altitude was associated with decreased Z-scores of height-for-age (β = -0·23, 95 % CI: -0·38, -0·08), Z-scores of weight-for-age (β = -0·24, 95 % CI: -0·39, -0·10). The OR for stunting and underweight were 2·03 (95 % CI: 1·51 to 2·73) and 2·04 (95 % CI: 1·38 to 3·02) per 1000 m increase in altitude, respectively; and OR increased rapidly at an altitude above 3500 m. The effects of long-term exposure to high altitudes on the prevalence of underweight in rural children were higher than that in urban children (P < 0·05).

CONCLUSIONS

High-altitude exposure is tightly associated with malnutrition among children under 5 years old. Improving children's nutrition is urgently needed in areas above 3500 m, especially in rural ones.

Estimation of Pubertal Growth-Spurt Parameters in Children and Adolescents in Colombia: Comparison between Low and Moderate Altitudes

Context-specific information, including differences in geographical areas, such as distinct altitudes, can be important to explain variations in physical growth. We aimed to compare the estimation of maximum growth velocity and pubertal growth-spurt parameters of children and adolescents living at low and moderate altitudes in Colombia. A cross-sectional study, including a representative cohort of 30.305 (51% boys) children and adolescents aged 1−18 years from Colombia, was performed. The heights were measured with standardized techniques. The Preece−Baines growth model was used to estimate the mathematical and biological parameters of the height-growth velocities and growth spurts for both sexes. The altitudes were categorized as low (18 to 564 m above sea level) or moderate (2420 to 2640 m above sea level). There were no differences in final height (h1), peak height velocity size (hθ), age at peak height velocity (APHV), or peak height velocity PHV (cm/y) between the subjects living in both altitudes (p > 0.05). The APHV was estimated at 12.75 ± 0.75 years in the boys and at 10.05 ± 0.65 years in the girls. The girls reached the APVH 2.70 years earlier than the boys. Regarding the PHV, the boys reached higher growth velocity, which was 6.85 ± 0.55 cm/y. In conclusion, there were no significant differences in final height, peak height, APHV, or PHV between the children and adolescents living at distinct altitudes in Colombia. The PHV occurred approximately 3 years earlier in the girls than in the boys. Furthermore, the girls’ estimated PHV, APHV, and final height were lower than those of the boys. This study allows additional insight into pubertal growth-spurt parameters and also provides a valuable reference database for the assessment of Colombian children and adolescents.

Birth Size and Maternal, Social, and Environmental Factors in the Province of Jujuy, Argentina

INTRODUCTION

birth size is affected by diverse maternal, environmental, social, and economic factors.

AIM

analyze the relationships between birth size-shown by the indicators small for gestational age (SGA) and large for gestational age (LGA)-and maternal, social, and environmental factors in the Argentine province of Jujuy, located in the Andean foothills.

METHODS

data was obtained from 49,185 mother-newborn pairs recorded in the Jujuy Perinatal Information System (SIP) between 2009 and 2014, including the following: newborn and maternal weight, length/height, and body mass index (BMI); gestational age and maternal age; mother's educational level, nutritional status, marital status and birth interval; planned pregnancy; geographic-linguistic origin of surnames; altitudinal place of birth; and unsatisfied basic needs (UBN). The dataset was split into two groups, SGA and LGA, and compared with adequate for gestational age (AGA). Bivariate analysis (ANOVA) and general lineal modeling (GLM) with multinomial distribution were employed.

RESULTS

for SGA newborns, risk factors were altitude (1.43 [1.12-1.82]), preterm birth (5.33 [4.17-6.82]), older maternal age (1.59 [1.24-2.05]), and primiparous mothers (1.88 [1.06-3.34]). For LGA newborns, the risk factors were female sex (2.72 [5.51-2.95]), overweight (1.33 [1.22-2.46]) and obesity (1.85 [1.66-2.07]).

CONCLUSIONS

the distribution of birth size and the factors related to its variability in Jujuy are found to be strongly conditioned by provincial terrain and the clinal variation due to its Andean location.

Newborn anthropometry, maternal capital, and altitude in the highland population from the province of Jujuy, Argentina

OBJECTIVE

To analyze variability in newborn (NB) anthropometry among Jujenean NBs as a function of geographic altitude (500 m to ≈4000 masl), maternal anthropometry and other maternal characteristics within the maternal capital framework.

MATERIALS AND METHODS

Data obtained from 41,371 mother/child pairs recorded in the Jujuy Perinatal Information System (SIP) between 2009 and 2014, including: NB and maternal weight, length/height and BMI; gestational age (corrected); maternal age, educational level, nutritional status, and marital status; birth interval; and planned pregnancy. Based on the declared place of residence, the prevalence of unsatisfied basic needs (% UBN) was determined and the data was split into two altitudinal groups: highlands (HL, >2500 masl) and lowlands (LL, <2500 masl). ANOVA, Chi-squared and Pearson tests were applied as needed. Statistical associations between the response variables-NB weight, length and BMI-and maternal and environmental variables were tested using a Generalized Additive Mixed Model (GAMM).

RESULTS

All NB and maternal anthropometric variables were lower in HL compared to LL; they also presented negative correlations with altitude, except NB length. Apart from gestational age and birth interval, HL and LL presented statistically significant differences in all study variables. GAMM results showed that maternal anthropometry was the main influence on NB weight and length.

DISCUSSION

Of all the maternal capital features examined, only maternal anthropometric variables were found to protect offspring against the negative impact of HL environments.

Proportionality indices, geographic altitude, and gestational age in newborns from Jujuy, Argentina

BACKGROUND

There are several different proportionality indices (PRIs) to evaluate size at birth by gestational age (GA). Yet, the explanatory power of alternative PRIs has not been evaluated in highland (HL) populations.

AIM

Evaluate the relative utility of three PRIs, weight to length ratio (W/L), body mass index (BMI), and ponderal index (PI), for assessing nutritional status in newborns (NBs) from highland (HL ≥ 2000 m) and lowland (LL < 2000 m) regions of the Jujuy Province of Argentina.

SUBJECTS AND METHODS

Births were registered by the Ministry of Health (Jujuy, 2009-2014). Data were grouped according to HL and LL altitude groups based on of maternal residence. The main outcome measures were the PRIs W/L ratio, BMI, and PI. Percentiles were generated by the LMS method and compared with references. ANOVAs and Pearson correlations were used to examine the relationship between outcome measures with weight and length by altitude, sex, and GA.

RESULTS

In both altitude zones, W/L and BMI increased with GA, while PI stabilized between 37th and 42th weeks. The LL sample had significantly higher values for all the PRIs from the 37th week of GA. In the HL sample, the 50th percentiles for all three PRIs were lower than the reference. Regardless of GA and altitude level, BMI showed the lowest correlation with length and the higher with the weight.

CONCLUSION

The HL sample of term NBs had lower values for all PRIs compared to their LL counterparts. In both altitude zones, the BMI is the preferred PRI to evaluate the nutritional status.

The relationship between residential altitude and stunting: evidence from >26 000 children living in highlands and lowlands of Ethiopia

Little information is known about the influence of altitude on child growth in Ethiopia, where most people live in highlands. We investigated the relation of residential altitude with growth faltering (stunting) of infants and young children in Ethiopia. We also examined whether the altitude-growth relationship was independent of the influence of the dietary and non-dietary determinants of growth. We used the data of 26 976 under-5-year-old children included in the Ethiopian Demographic and Health Surveys, conducted from 2005 to 2016. The samples were recruited following a two-stage cluster sampling strategy. Stunting was defined by height-for-age <-2 z-scores. The relationship between residential altitude and stunting was examined by running multiple logistic regression analysis, controlling the effect of covariate dietary and non-dietary variables. The residential altitude of the study participants ranged from -116 to 4500 m above sea level (masl). There was a significant and progressive increase in the prevalence and odds of stunting with increasing altitude (P < 0·001), irrespective of the dietary and non-dietary predictors of stunting. The prevalence of stunting was lowest in lowlands (39 %) and highest in highlands (47 %). Compared with altitude <1000 masl, the odds of stunting was 1·41 times higher at altitude ≥2500 masl (OR 1·41, 95 % CI 1·16, 1·71) and 1·29 times higher at altitude 2000-2499 masl (OR 1·29, 95 % CI 1·11, 1·49). Children living in highlands might be at a higher risk of poor growth. Further studies are warranted to understand the mechanism behind the observed altitude-stunting link and identify strategies to compensate for the growth-faltering effect of living in highlands.

Geographic altitude and prevalence of underweight, stunting and wasting in newborns with the INTERGROWTH-21st standard

OBJECTIVE

To assess the prevalence and risks of underweight, stunting and wasting by gestational age in newborns of the Jujuy Province, Argentina at different altitude levels.

METHODS

Live newborns (n=48,656) born from 2009-2014 in public facilities with a gestational age between 24⁺⁰ to 42⁺⁶ weeks. Phenotypes of underweight (<P3weight/age), stunting (<P3length/age) and wasting (<P3body mass index/age) were calculated using INTERGROWTH-21st standards. Risk factors were maternal age, education, body mass index, parity, diabetes, hypertension, preeclampsia, tuberculosis, prematurity, and congenital malformations. Data were grouped by the geographic altitude: ≥2.000 or <2.000m.a.s.l. Chi-squared test and a multivariate logistic regression analysis were performed to estimate the risk of the phenotypes associated with an altitudinal level ≥2.000m.a.s.l.

RESULTS

The prevalence of underweight, stunting and wasting were 1.27%, 3.39% and 4.68%, respectively, and significantly higher at >2.000m.a.s.l. Maternal age, body mass index >35kg/m², hypertension, congenital malformations, and prematurity were more strongly associated with underweight rather than stunting or wasting at ≥2.000m.a.s.l.

CONCLUSIONS

Underweight, stunting, and wasting risks were higher at a higher altitude, and were associated with recognized maternal and fetal conditions. The use of those three phenotypes will help prioritize preventive interventions and focus the management of fetal undernutrition.

Education, Altitude, and Humidity Can Interactively Explain Spatial Discrepancy and Predict Short Stature in 213,795 Chinese School Children

Backgrounds and Objectives: The north-south height distinctions in Chinese children suggest that some geographical-climatic factors could determine height variation of short stature. In a national health survey, we aimed to explore the spatial distribution of short stature on city scales, and detect its socio-economic and geographical-climatic factors. Methods: Data on the prevalence of short stature were obtained from a 2014 cross-sectional survey of China (CNSSCH). In total, 213,795 Han Chinese students aged 7-18 years, from 106 cities across 30 provinces, were included. Both China and World Health Organization (WHO) growth references were adopted to define short stature. Results: A spatial clustering was apparent in the distribution of short stature. After multivariable adjustment, altitude and humidity significantly increased the risk of high prevalence in short stature, according to the WHO (odds ratio [OR] = 1.61 and 1.26, 95% confidence interval [CI]: 1.20-2.17 and 1.03-1.54) and China (OR = 1.54 and 1.26; 95% CI: 1.15-2.05 and 1.02-1.55) growth references. Additionally, education significantly decreased the risk of high prevalence in short stature according to the WHO (OR = 0.40; 95% CI: 0.22-0.74) and China (OR = 0.42; 95% CI: 0.22-0.77) growth references. Combining both altitude >400 m and education <9 years, as well as education <9 years and humidity >70%, received the largest effect-size estimate, and significance retained after multivariable adjustment. Conclusions: Our findings indicate that high altitude and humidity increased the risk of high prevalence in short stature, high education was associated with low prevalence. Additionally, we observed possible interactions between education and altitude/humidity. They may interactively explain spatial discrepancy and predict short stature in Chinese school children. Further validations are necessary.

Vitamin D status is associated with underweight and stunting in children aged 6-36 months residing in the Ecuadorian Andes

OBJECTIVE

There is limited knowledge on vitamin D status of children residing in the Andes and its association with undernutrition. We evaluated the vitamin D status of children residing in a low socio-economic status (SES) setting in the Ecuadorian Andes and assessed the association between vitamin D status, stunting and underweight. We hypothesized that children who were underweight would have lower serum 25-hydroxyvitamin D (25(OH)D) levels and lower 25(OH)D levels would be associated with a higher risk of stunting.

DESIGN

We conducted a cross-sectional secondary analysis of a randomized controlled trial, the Vitamin A, Zinc and Pneumonia study. Children had serum 25(OH)D concentrations measured. A sensitivity analysis was undertaken to determine a vitamin D cut-off specific for our endpoints. Associations between serum 25(OH)D and underweight (defined as weight-for-age Z-score≤-1) and stunting (defined as height-for-age Z-score≤-2) were assessed using multivariate logistic regression.

SETTING

Children residing in five low-SES peri-urban neighbourhoods near Quito, Ecuador.

SUBJECTS

Children (n 516) aged 6-36 months.

RESULTS

Mean serum 25(OH)D concentration was 58·0 (sd 17·7) nmol/l. Sensitivity analysis revealed an undernutrition-specific 25(OH)D cut-off of <42·5 nmol/l; 18·6 % of children had serum 25(OH)D<42·5 nmol/l. Children who were underweight were more likely to have serum 25(OH)D<42·5 nmol/l (adjusted OR (aOR)=2·0; 95 % CI 1·2, 3·3). Children with low serum 25(OH)D levels were more likely to be stunted (aOR=2·8; 95 % CI 1·6, 4·7).

CONCLUSIONS

Low serum 25(OH)D levels were more common in underweight and stunted Ecuadorian children.

A decade of rapid change: Biocultural influences on child growth in highland Peru

OBJECTIVES

In the past decade many areas of Peru have been undergoing extreme environmental, economic, and cultural change. In the highland hamlet of Chugurpampa, La Libertad, climate change has ruined harvests and led to frequent periods of migration to the coast in search of livelihood. This biocultural research examines how the changes could be affecting the growth of children who maintain residence in the highlands.

METHODS

Clinical records from the early 2000s were compared to those from the early 2010s. Charts were randomly selected to record anthropometric data, netting a sample of 75 children ages 0-60 months of age. Analysis of covariance was run to compare mean stature, weight, and BMI between cohorts. Percentage of children who fall below the -2 threshold for z-scores for height and weight were compared by age and cohort.

RESULTS

A significant secular trend in growth was found, with children born more recently larger than those born a decade before. The effect is most notable in the first year of life, with the growth advantage attenuated by the age of 3 for height and age 4 for weight. While children were unlikely to be stunted from 0 to 3 years of age, 44% of the later cohort were stunted and 11% were underweight from 4 to 5 years of age.

CONCLUSIONS

Three possible explanations for the rapid shift are entertained: more time spent on the coast during gestation and early childhood, which may attenuate the effect of hypoxia on child growth; dietary change; and increased use of biomedicine.