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Am J Clin Nutr. 2014 Sep;100(3):821-5. doi: 10.3945/ajcn.114.084368. Epub 2014 Jul 9.

Height-for-age z scores increase despite increasing height deficits among children in 5 developing countries.

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From Nutrition and Health Sciences program, Graduate Division of Biological and Biomedical Sciences (EAL), and Rollins School of Public Health, Hubert Department of Global Health (ADS and RM), Emory University, Atlanta, GA; Gillings School of Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC (LSA); Economics, Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA (JRB); Sunderlal Jain Hospital, New Delhi, India (SKB); the Department of International Health, Boston University School of Public Health, and Center for Global Health and Development, Boston University, Boston, MA (KAD); the Developmental Pathways to Health Research Unit, University of Witwatersrand, Johannesburg, South Africa (EAL, ADS, SAN, and LMR); Human Sciences Research Council, Durban, South Africa (LMR); the Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (CHDF); Sitaram Bhartia Institute of Science and Research, New Delhi, India (HSS); and Universidade Federal de Pelotas, Pelotas, Rio Grande do Sol, Brazil (DG and CGV).



Growth failure remains a persistent challenge in many countries, and understanding child growth patterns is critical to the development of appropriate interventions and their evaluation. The interpretation of changes in mean height-for-age z scores (HAZs) over time to define catch-up growth has been a subject of debate. Most studies of child growth have been cross-sectional or have focused on children through age 5 y.


The aim was to characterize patterns of linear growth among individuals followed from birth into adulthood.


We compared HAZs and difference in height (cm) from the WHO reference median at birth, 12 mo, 24 mo, mid-childhood, and adulthood for 5287 individuals from birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa.


Mean HAZs were <0 at birth in the 3 cohorts with data and ranged from -0.6 (Brazil) to -2.9 (Guatemala) at age 24 mo. Between 24 mo and mid-childhood, HAZ values increased by 0.3-0.5 in South Africa, Guatemala, and the Philippines and were unchanged in Brazil and India. Between mid-childhood and adulthood, mean HAZs increased in all cohorts but remained <0 in adulthood [mean range: -0.3 (Brazil) to -1.8 (Guatemala and Philippines)]. However, from 24 mo to adulthood, height differences from the reference median became greater.


From age 2 y to adulthood, mean HAZs increased, even though height deficits relative to the reference median also increased. These 2 metrics may result in different interpretations of the potential for and the impact of catch-up growth in height.

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