Institute of Biology and Biochemistry, Human Biology, University of Potsdam, Am Neuen Palais 10, 14467Potsdam, Germany.
School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK.
Public Health Nutr. 2021 Jan;24(1):52-61. doi: 10.1017/S1368980020003067. Epub 2020 Sep 14.
Stunting (height-for-age < -2 sd) is one of the forms of undernutrition and is frequent among children of low- and middle-income countries. But stunting perse is not a synonym of undernutrition. We investigated association between body height and indicators of energetic undernutrition at three critical thresholds for thinness used in public health: (1) BMI SDS < -2; (2) mid-upper arm circumference divided by height (MUAC (mm) × 10/height (cm) < 1·36) and (3) mean skinfold thickness (SF) < 7 mm and to question the reliability of thresholds as indicators of undernutrition.
Cross-sectional study; breakpoint analysis.
Rural and urban regions of Indonesia and Guatemala - different socio-economic status (SES).
1716 Indonesian children (6·0-13·2 years) and 3838 Guatemalan children (4·0-18·9 years) with up to 50 % stunted children.
When separating the regression of BMI, MUAC or SF, on height into distinguishable segments (breakpoint analysis), we failed to detect relevant associations between height, and BMI, MUAC or SF, even in the thinnest and shortest children. For BMI and SF, the breakpoint analysis either failed to reach statistical significance or distinguished at breakpoints above critical thresholds. For MUAC, the breakpoint analysis yielded negative associations between MUAC/h and height in thin individuals. Only in high SES Guatemalan children, SF and height appeared mildly associated with R2 = 0·017.
Currently used lower thresholds of height-for-age (stunting) do not show relevant associations with anthropometric indicators of energetic undernutrition. We recommend using the catch-up growth spurt during early re-feeding instead as immediate and sensitive indicator of past undernourishment. We discuss the primacy of education and social-economic-political-emotional circumstances as responsible factors for stunting.
发育迟缓（身高年龄<-2sd）是营养不良的一种形式，在中低收入国家的儿童中很常见。但发育迟缓本身并不是营养不良的同义词。我们调查了身体高度与三种用于公共卫生的消瘦临界阈值下的能量营养不良指标之间的关联：（1）BMI SDS <-2；（2）上臂中部周长除以身高（MUAC（mm）×10/身高（cm）<1.36）和（3）平均皮褶厚度（SF）<7mm，并质疑这些阈值作为营养不良指标的可靠性。
横断面研究；断点分析。
印度尼西亚和危地马拉的农村和城市地区-不同的社会经济地位（SES）。
1716 名印度尼西亚儿童（6.0-13.2 岁）和 3838 名危地马拉儿童（4.0-18.9 岁），其中多达 50%的儿童发育迟缓。
当将 BMI、MUAC 或 SF 对身高的回归分成可区分的部分（断点分析）时，即使在最瘦和最短的儿童中，我们也未能检测到身高与 BMI、MUAC 或 SF 之间的相关关联。对于 BMI 和 SF，断点分析要么未能达到统计学意义，要么在临界阈值以上的断点处区分。对于 MUAC，在瘦弱个体中，MUAC/h 与身高之间的断点分析呈负相关。只有在 SES 较高的危地马拉儿童中，SF 和身高与 R2=0.017 有轻微关联。
目前使用的身高年龄较低阈值（发育迟缓）与能量营养不良的人体测量指标没有明显关联。我们建议在早期重新喂养期间使用追赶生长突增作为过去营养不良的直接和敏感指标。我们讨论了教育以及社会经济政治情感环境作为导致发育迟缓的首要因素的重要性。
