Progression of stunting and its predictors among school-aged children in western Kenya

Friedman, J. F., Phillips-Howard, P. A., Mirel, L. B., Terlouw, Anja ORCID: https://orcid.org/0000-0001-5327-8995, Okello, N., Vulule, J. M., Hawley, W. A., Nahlen, B. L. and terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617 (2005) 'Progression of stunting and its predictors among school-aged children in western Kenya'. European Journal of Clinical Nutrition, Vol 59, Issue 8, pp. 914-922.

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Abstract

Objective: The objectives of this study were (1) to assess whether a cohort of school-aged children experiences progression of stunting over a 2-y-period of observation and (2) to identify baseline nutritional and body composition risk factors for the progression of stunting.

Methods: As part of a large-scale, randomized controlled trial assessing the impact of insecticide-treated bednets (ITNs) on nutritional status, we longitudinally followed a cohort of school-aged children over a 2-y-period in western Kenya. Anthropometric measurements were made at four time points from which Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and body mass index (BMIZ) were calculated. Two measures of body composition, upper arm fat area and upper arm muscle area, were derived from mid-upper arm circumference (MUAC) and triceps skinfold thickness.

Results: Subjects experienced a mean change in HAZ from baseline to 9 months of -0.16 [-0.19, -0.13], from baseline to 16 months of -0.18 [-0.22, -0.15], and from baseline to 24 months of -0.36 [-0.41, -0.31]. Thus, the average individual's change in HAZ at the three follow-up time points is significantly less than zero, meaning that, on average, the cohort is deviating further from NCHS reference medians over time. The baseline nutritional measure that explained the greatest amount of variance in the progression of stunting was the upper arm muscle area Z-score (F=8.1; P=0.005).

Conclusions: This longitudinal study provides further evidence from a distinct ecological setting regarding the progression of undernutrition during middle childhood in the developing world. It suggests that school-aged children in the developing world do not experience catch-up growth or remain stable. Rather, they continue to deviate from NCHS standards, accruing greater height deficits with age. In addition, absolute lean body mass explained the most variability in the progression of stunting, which supports cross-sectional findings from other studies.

Item Type:	Article
Uncontrolled Keywords:	malnutrition, body mass index, height, menarche, adolescence, Kenya
Subjects:	WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria WS Pediatrics > Child Care. Nutrition. Physical Examination > WS 130 In childhood
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI):	https://doi.org/10.1038/sj.ejcn.1602161
Depositing User:	Ms Julia Martin
Date Deposited:	21 Dec 2011 10:10
Last Modified:	11 Jan 2021 14:18
URI:	https://archive.lstmed.ac.uk/id/eprint/1886

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