Growth faltering and catch‐up growth in relation to environmental change in children of a disadvantaged community from Guatemala City

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Abstract
The extent and persistence of stunting and growth status across a 10‐year period, and their relationship to changes in the home environment, have been analyzed using data from a 10‐year longitudinal study of three birth cohorts, seen initially at 3, 5, and 7 years and examined annually thereafter. The children came from an economically disadvantaged community located on the periphery of Guatemala City. The sample used in the analysis consisted of 271 subjects with complete growth and SES data over a 10‐year period. Stunting was high initially, with 43.5% of the sample displaying USNCHS height z‐scores < −2.0 at the first examination. Growth status at the first visit was a significant predictor of status after 10 years. The odds ratio for stunting in adolescence if stunted in early childhood was 18.39. Characteristics of the household at the first visit were a significant determinant of height, weight, estimated arm muscle, the triceps skinfold, and the BMI at the last visit, after adjusting for confounding variables. Changes in household status between the first and last visits were associated with greater growth increments in height and weight but not in the BMI, triceps skinfold, or estimated arm muscle circumference. These analyses have demonstrated that improved growth status during adolescence relative to status 10 years earlier (a form of catch‐up growth) was attributable to two factors: first, for the sample as a whole there was a general improvement in growth status with a mean change in height‐and weight‐for‐age z‐scores of 0.218 and 0.420, respectively; second, the change in household score from first to last visit was a significant determinant of growth increment over that period, but only in the case of height and weight. Thus, while the early environment is a powerful determinant of later growth status, some catch‐up growth can be identified both as a general systemic response as well as a response to changing environmental conditions.