Growth Faltering or Deceleration Toward Genetic Target Height: Linear Growth Interpretation Using WHO Growth Standard for Indonesian Children
Annang Giri Moelyo1,2, Mei Neni Sitaresmi3 , and Madarina Julia3
1 Doctorate program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. 2 Department of Child Health, Faculty of Medicine/Dr. Moewardi Hospital, Universitas Sebelas Maret, Surakarta, Indonesia. 3 Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Abstract
Background: Child growth patterns, particularly in low- and low-middle-income countries, showed a faltering in early childhood, according to WHO standards. On the other hand, healthy infants grow toward their genetic potential for height in the first years of life and then grow in a predictable trajectory called “canalization” or channeling. We aimed to critically interpret the decline in height-for-age Z-scores (HAZ), as the possibility of growth deceleration toward genetic target height, when the growth of under-five Indonesian children were compared to the WHO 2006 growth standard.
Methods: We used data on age, gender, height, BMI, parental height and education, household socioeconomic status and place of residences in children aged < 5 years old collected by the Indonesia Family Life Survey (IFLS) in 1993, 2000, 2007, and 2014. The height-for-age z-score (HAZ) was calculated according to the WHO 2006 growth standard. The target heights of the children were calculated based on their parental heights and converted to target height z-scores (THz). The discrepancies between HAZ and THz were measured to analyze their pattern in the first 5 years of life.
Findings: The study included 11,241 subjects from four surveys. A decrease in HAZ occurred from birth to approximately 2 years of age to reach the target height in all waves and to remain stable or increase after 2 years of age. The patterns were similar in children living in urban and rural areas, and the gap between both areas narrowed from 1993 to 2014. The discrepancies between HAZ and THz in overweight–obese subjects increased after 2 years of age, while remaining stable in the other two nutritional status groups.
Interpretations: We observed a deceleration toward genetic target height, not growth faltering, in the first 2 years of the life of Indonesian children. After 21 years, the gap of deceleration toward their genetic target height between living in urban and rural areas appeared to narrow. Overweight-obese children had an earlier decrease in HAZ than other nutritional status groups.
Funding: The authors declare that there is no funding for this study.
Declaration of Interest: None to declare.
Keywords: growth faltering, genetic target height, linear growth
Moelyo, Annang Giri and Sitaresmi, Mei Neni and Julia, Madarina, Growth Faltering or Deceleration Toward Genetic Target Height: Linear Growth Interpretation Using WHO Growth Standard for Indonesian Children. Available at SSRN: https://ssrn.com/abstract=4409334 or http://dx.doi.org/10.2139/ssrn.4409334