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

European Journal of Clinical Nutrition volume 59, pages 914–922 (2005)Cite this article

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.

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Acknowledgements

We thank the Centers for Disease Control and Prevention/Kenya Medical Research Institute field teams and support staff for their assistance with this project. We thank Marlene Barber for support with data management. We thank the students, teachers and headmasters for their time and participation. We are grateful to Hemal Kanzaria for careful review of this manuscript. We also thank the director of the Kenya Medical Research Institute for his permission to publish this work.

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Authors and Affiliations

  1. US Department of State, Institute of International Education, Fulbright Fellowships, Washington, DC, USA

    J F Friedman

  2. International Health Institute and Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA

    J F Friedman

  3. Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

    P A Phillips-Howard, L B Mirel, D J Terlouw, W A Hawley, B L Nahlen & F ter Kuile

  4. Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya

    P A Phillips-Howard, N Okello, J M Vulule & F ter Kuile

  5. Department of Infectious Diseases, Tropical Medicine & Aids, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    F ter Kuile

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Friedman, J., Phillips-Howard, P., Mirel, L. et al. Progression of stunting and its predictors among school-aged children in western Kenya. Eur J Clin Nutr 59, 914–922 (2005). https://doi.org/10.1038/sj.ejcn.1602161

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