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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.

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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).

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Correspondence to S Dang.

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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.

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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).

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