Article based on Young Lives data from the UK Data Archive  by authors from IFPRI, Cornell University and the University of South Carolina.

Background

Evidence from studies conducted in nutritionally deprived children in low- and middle-income countries (LIMC) in past decades showed little or no population-level catch-up in linear growth (mostly defined as reductions in the absolute height deficit) after 2 years of age. Recent studies, however, have reported population-level catch-up growth in children, defined as positive changes in mean height-for-age z-scores (HAZ). The aim of this paper was to assess whether population-level catch-up in linear growth is found when height-for-age difference (HAD: child’s height compared to standard, expressed in centimeters) is used instead of HAZ. Our premise is that HAZ is inappropriate to measure changes in linear growth over time because they are constructed using standard deviations from cross-sectional data.

Methods

We compare changes in growth in populations of children between 2 and 5 years using HAD vs. HAZ using cross-sectional data from 6 Demographic and Health Surveys (DHS) and longitudinal data from the Young Lives and the Consortium on Health-Orientated Research in Transitional Societies (COHORTS) studies.

Results

Using HAD, we find not only an absence of population-level catch-up in linear growth, but a continued deterioration reflected in a decrease in mean HAD between 2 and 5 years; by contrast, HAZ shows either no change (DHS surveys) or an improvement in mean HAZ (some of the longitudinal data). Population-level growth velocity was also lower than expected (based on standards) in all four Young Lives data sets, confirming the absence of catch-up growth in height.

Discussion

We show no evidence of population-level catch-up in linear growth in children between 2 to 5 years of age when using HAD (a measure more appropriate than HAZ to document changes as populations of children age), but a continued deterioration reflected in a decrease in mean HAD.

Conclusions
The continued widening of the absolute height deficit after 2 years of age does not challenge the critical importance of investing in improving nutrition during the first 1000 days (i.e., from conception to 2 years of age), but raises a number of research questions including how to prevent continued deterioration and what is the potential of children to benefit from nutrition interventions after 2 years of age. Preventing, rather than reversing linear growth retardation remains the priority for reducing the global burden of malnutritionworldwide.

Keywords: Catch-up growth; Linear growth retardation; 1000 days; Children

Jef L. Leroy, Marie Ruel, Jean-Pierre Habicht and Edward A. Frongillo (2015) 'Using Height-for-Age Differences (HAD) instead of Height-for-Age Z-Scores (HAZ) for the Meaningful Measurement of Population-level Catch-up in Linear Growth in Children Less than 5 Years of Age', BMC Pediatrics 2015 15: 145, DOI: 10.1186/s12887-015-0458-9.

See also 2 related blog posts:
'Catching up with the debate on catch up growth and development for young children', Development Horizons, 18 Dec 2015
'Once stunted always stunted? What’s up with catch-up growth?', IFPRI Agriculture for Nutrition and Health blog, 3 Nov 2015