Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

High altitude and early childhood growth retardation: new evidence from Tibet



To assess possible effect of high altitude on early childhood growth in Tibet.


A cross-sectional survey on child health and nutrition was conducted in Tibet with stratified multistage cluster random sampling technique. Height and weight status of Tibetan children <36 months of age was measured. A questionnaire was administered to mothers of children for information on family background, child feeding practice and health care and maternal care. A total of 1458 children with complete information were used for analysis. A logistic regression model was used to control for selected potential confounding factors and then observed altitude effect on growth of Tibetan children.


Positive association of stunting with altitude was observed for each age group, even after controlling for selected potential affecting factors. Children above 3500 m had two to six times risk of getting stunting compared with those at 3000 m when socioeconomic and other factors were controlled. Effect of altitude on underweight was observed only among children <24 months old and significant increase in odds ratio appeared only above 4000 m after controlling for those confounding factors. Indicator of wasting was not related to altitude.


Altitude might result in a delay in height of younger Tibetan children, independent of socioeconomic and other factors operating through nutrition and disease, and took adverse effect persistently through birth to 3 years old. Its adverse effect on weight could be limited. For comparison and assessment of nutritional status of Tibetan children, the effect of altitude on growth should be taken into account.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Figure 1


  • Beall CM (1981). Growth in a population of Tibetan origin at high altitude. Ann Hum Biol 8, 31–38.

    Article  CAS  Google Scholar 

  • Beall CM (2000). Tibetan and Andean contrasts in adaptation to high-altitude hypoxia. Adv Exp Med Biol 475, 63–74.

    Article  CAS  Google Scholar 

  • Binkin NJ, Yip R, Fleshood L, Trowbridge FL (1988). Birth weight and childhood growth. Pediatrics 82, 828–834.

    CAS  PubMed  Google Scholar 

  • Dang S, Yan H, Yamamoto S, Wang X, Zeng L (2004). Poor nutritional status of younger Tibetan children living at high altitudes. Eur J Clin Nutr 58, 938–946.

    Article  CAS  Google Scholar 

  • de Meer K, Bergman R, Kusner JS, Voorhoeve HW (1993). Differences in physical growth of Aymara and Quechua children living at high altitude in Peru. Am J Phys Anthropol 90, 59–75.

    Article  CAS  Google Scholar 

  • Deng XP, PingCuo ZG, NiMa D (1991). Analysis on birth weight of 3939 newborn Tibetan and Han nationality children in Lhasa area, China. J Tibetan Med 12, 46–47.

    Google Scholar 

  • Dibley MJ, Staehling N, Neiburg P, Towbridge FL (1987). Interpretation of z-score anthropometic indicators derived from the international growth reference. Am J Clin Nutr 46, 749–762.

    Article  CAS  Google Scholar 

  • Frongillo Jr EA, de Onis M, Hanson KM (1997). Socioeconomic and demographic factors are associated with worldwide patterns of stunting and wasting of children. J Nutr 127, 2302–2309.

    Article  CAS  Google Scholar 

  • Haas JD, Moreno-Black G, Frongillo Jr EA, Pabon J, Pareja G, Ybarnegaray J et al. (1982). Altitude and infant growth in Bolivia: a longitudinal study. Am J Phys Anthropol 59, 251–262.

    Article  CAS  Google Scholar 

  • Harris NS, Crawford PB, Yangzom Y, Pinzo L, Gyaltsen P, Hudes M (2001). Nutritional and health status of Tibetan children living at high altitudes. N Engl J Med 344, 341–347.

    Article  CAS  Google Scholar 

  • Kikafunda JK, Walker AF, Collett D, Tumwine JK (1998). Risk factors for early childhood malnutrition in Uganda. Pediatrics 102, E45 [cited May 11, 2005]. Available from:URT:

    Article  CAS  Google Scholar 

  • Leonard WR, DeWalt KM, Stansbury JP, McCaston MK (1995). Growth differences between children of highland and coastal Ecuador. Am J Phys Anthropol 98, 47–57.

    Article  CAS  Google Scholar 

  • Liu R (1988). China Population, Section of Tibet. Publishing House of Finance and Economy: Beijing.

    Google Scholar 

  • Lohman TG, Roche AF, Martorell R (1991). Anthropometric Standardization Reference Manual (Abridged Edition). Human Kinetics Books: Champaign Illinois.

    Google Scholar 

  • Moore LG, Young D, McCullough RE, Droma T, Zamudio S (2001). Tibetan protection from intrauterine growth restriction (IUGR) and reproductive loss at high altitude. Am J Hum Biol 13, 635–644.

    Article  CAS  Google Scholar 

  • Nandy S, Irving M, Gordon D, Subramanian SV, Smith GD (2005). Poverty, child undernutrition and morbidity: new evidence from India. Bull World Health Organ 83, 210–216.

    PubMed  PubMed Central  Google Scholar 

  • Niermeyer S, Yang P, Shanmina, Drolkar, Zhuang J, Moore LG (1995). Arterial oxygen saturation in Tibetan and Han infants born in Lhasa, Tibet. N Engl J Med 333, 1248–1252.

    Article  CAS  Google Scholar 

  • Obert P, Fellmann N, Falgairette G, Bedu M, Van Praagh E, Kemper H et al. (1994). The importance of socioeconomic and nutritional conditions rather than altitude on the physical growth of prepubertal Andean highland boys. Ann Hum Biol 21, 145–154.

    Article  CAS  Google Scholar 

  • Pawson IG (1977). Growth characteristics of populations of Tibetan origin in Nepal. Am J Phys Anthropol 47, 473–482.

    Article  CAS  Google Scholar 

  • Physical status: the use and interpretation of anthropometry Report of a WHO expert committee. WHO Tech Rep Ser 1995 854.

  • Stephensen CB (1999). Burden of infection on growth failure. J Nutr 129, 534S–538S.

    Article  CAS  Google Scholar 

  • Weitz CA, Garruto RM (2004). Growth of Han migrants at high altitude in central Asia. Am J Hum Biol 16, 405–419.

    Article  Google Scholar 

  • Weitz CA, Garruto RM, Chin CT, Liu JC, Liu RL, He X (2000). Growth of Qinghai Tibetans living at three different high altitudes. Am J Phys Anthropol 111, 69–88.

    Article  CAS  Google Scholar 

  • Yip R (1987). Altitude and birth weight. J Pediatr 111, 869–876.

    Article  CAS  Google Scholar 

  • Yip R, Nancy JB, Frederick LT (1988). Altitude and children growth. J Pediatr 113, 486–489.

    Article  CAS  Google Scholar 

  • Zamudio S, Droma T, Norkyel KY, Acharya G, Zamudio JA, Niermeyer SN et al. (1993). Protection from intrauterine growth retardation in Tibetans at high altitude. Am J Phys Anthropol 91, 215–224.

    Article  CAS  Google Scholar 

Download references


We thank the women and their children participated in our survey. We thank Minster of Health, People's Republic of China and United Nations Children's Fund for support and cooperation; Minster of Health, Tibet and local health bureau and MCH stations of Lhasa, Nyingchi, Xigaze, Lhokha, Chamdo, Nagchu and Ngari districts for cooperation and organization in the field data collection; and staff from MCH stations and Xi'an Jiaotong University for participation in the field data collection. We thank especially Dr Ray Yip for his constructive suggestions in the preparation of research protocol and data collection and processing.

This study was sponsored and funded by the Ministry of Health, People's Republic China and Untied Nations Children's Fund (UNICEF).

Author information

Authors and Affiliations


Corresponding author

Correspondence to S Dang.

Additional information

Guarantor: H Yan.

Contributors: SD was involved in the preparation of the research protocol, field management, collection and analysis of data and manuscript writing. HY was responsible for design of research and sampling, and preparation of protocol. SY provided significant study advices, guidance on the data analysis and interpretation, and manuscript writing.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dang, S., Yan, H. & Yamamoto, S. High altitude and early childhood growth retardation: new evidence from Tibet. Eur J Clin Nutr 62, 342–348 (2008).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • growth
  • malnutrition
  • altitude
  • Tibetan child

This article is cited by


Quick links