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Background Children living at high altitudes often have delayed growth, but whether growth retardation is related to altitude or to other factors is not known.
Methods A multicultural health care team assessed 2078 Tibetan children 0 to 84 months of age for anthropometric and clinical signs of malnutrition. The children lived in 11 counties, which contained more than 50 diverse urban and nonurban (nomadic, agricultural, or periurban) communities in the Tibet Autonomous Region of China. The height and weight of the children were compared with those of U.S. children. Height and weight were expressed as z scores (the number of standard deviations from the median of the age- and sex-specific reference group).
Results The mean z score for height fell from –0.5 to –1.6 in the first 12 months of life and generally ranged from –2.0 to –2.4 in older children. Overall, of 2078 children, 1067 (51 percent) had moderately or severely stunted growth, as defined by a z score of –2.0 or lower. Of the 1556 children 24 months of age or older, 871 (56 percent) had stunted growth, which was severe (z score, –3.0 or lower) in 380 (24 percent). Among the children in this age group, 787 of the 1313 nonurban children (60 percent) had stunting, as compared with 84 of the 243 urban children (35 percent). Stunting was associated with clinical conditions such as rickets, abdominal distention, hair depigmentation, and skin lesions and with a maternal history of hepatitis or goiter. Stunting was not associated with altitude, after adjustment for the type of community.
Conclusions In Tibetan children, severe stunting due to malnutrition occurs early in life, and morbidity is high.
Source Information
From the Tibet Child Nutrition and Collaborative Health Project, Public Health Institute, Santa Cruz, Calif. (N.S.H.); the Department of Nutritional Sciences, University of California at Berkeley, Berkeley (P.B.C., M.H.); and the Department of Pediatrics and Medical Research (Y.Y., L.P.) and the Tibet Medical Research Institute (P.G.), First People's Hospital, Lhasa, Tibet Autonomous Region of China.
Address reprint requests to Dr. Crawford at the Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA 94720, or at pbcraw{at}uclink4.berkeley.edu.
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