Sports-related factors and stunting in children under 5 years old: a cross-sectional study across 471 counties in 31 provincial regions of China.

Globally, approximately 148.1 million children are affected by stunting, significantly threatening their health and cognitive development. This nationwide cross-sectional study uniquely focused on sports-related factors, including family sports-related spending, duration of physical activity, and consistent participation in sports. Using data involving 5,017 children under 5 years old from 471 counties across 31 provinces in China, significant socioeconomic, regional, and behavioral correlates of stunting were identified. Stunting prevalence differed notably by gender and geographical division, with boys having significantly higher odds of stunting compared to girls (OR = 1.539; 95% CI: 1.238-1.913; p < 0.001), and children in East China having significantly lower odds compared to those in Northwest China (OR = 0.566; 95% CI: 0.398-0.804; p = 0.002). Non-enrolled children exhibited significantly increased odds of stunting (OR = 2.266; 95% CI: 1.360-3.775; p = 0.002). Increased sports-related family spending was associated with lower odds of child stunting (OR = 0.730; 95% CI: 0.580-0.919; p = 0.007). Furthermore, children with insufficient daily physical activity (0-15 min/day) were more likely to experience stunting compared to those exercising over 60 min per day (OR = 1.413; 95% CI: 1.030-1.937; p = 0.032). Long-term consistent participation in sports (participation duration over 3 months) significantly reduced stunting risk (< 1 month vs. >3 months, OR = 1.432; 95%CI: 1.023-2.006, p= 0.036). Screen time and sleep duration showed no significant associations with childhood stunting in this study (p > 0.05). Thus, we recommend increasing family sports-related investments and encouraging regular and long-term participation in physical activities, especially targeting low-income families, to support child growth and reduce the risk of stunting.