Children Residing at Higher Altitudes Are Born Shorter and Have Lower Growth Trajectory

MedicalResearch.com Interview with:
Kaleab Baye PhD

Center for Food Science and Nutrition
Addis Ababa University

MedicalResearch.com: What is the background for this study?

Response: Reducing child stunting is one of the most important objectives of the Sustainable development goals (SDGs) and the World Health Assembly (WHA). Progress is routinely measured using anthropometric indices such as height-for-age z score that compare child height to the World Health Organization (WHO) growth standards. Such comparisons rely on the assumption that children living in ideal home environment that promotes adequate growth have the same growth potential, irrespective of their genetic make-up. This assumption was confirmed by the Multicenter Growth Reference Study (MGRS), which was the origin of the development of the growth standards. However, the MGRS excluded sites above 1500 m above sea level (asl); hence, it remains unclear whether the widely adopted WHO growth standards are applicable to populations above the 1500 m asl threshold.

This study investigated the association between altitude and linear growth faltering and evaluated whether the prescriptive WHO growth standards can apply to children residing at higher altitudes.

MedicalResearch.com: What are the main findings?

Response: In this study that included height measurements from close to one million children in 59 low and middle income countries, we found that children residing at higher altitude were on average born shorter, and remained on a lower growth trajectory than children residing at lower altitudes. The altitude mediated growth deficits were biologically significant and applied even for children living in ideal home environments, previously proven to allow children reach their growth potential. The level of growth deficits associated to residence at higher altitude equated levels that needed four decades of intensive nutrition-sensitive and nutrition-specific interventions in the Gambia. This is the first global study that evaluated the role of altitude on child growth, applying the ideal home environment concept. The study does not support downward adjustment of the WHO growth standards by altitude, because the growth deficits starting in utero are likely caused by altitude-induced chronic hypoxia, with potentially serious functional deficits. 

MedicalResearch.com: What should readers take away from your report?

Response: Given that 12% of the world population, mostly in Africa and Asia-where the burden of stunting is the highest- reside at altitude higher than 1500m asl, future research should focus in unraveling the complex relationship between altitude, hypoxia, and fetal growth. Which set of interventions during pregnancy and afterwards can reduce the risk of growth faltering related to residence at higher altitude requires urgent attention.

 MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Specific health care guidance and monitoring are needed for the management of pregnancies and early child development at higher altitudes. Failing to address altitude-mediated growth deficits can impede progress towards meeting the SDGs and the WHA nutrition targets.

Any disclosures? None


Baye K, Hirvonen K. Evaluation of Linear Growth at Higher Altitudes. JAMA Pediatr. Published online August 24, 2020. doi:10.1001/jamapediatrics.2020.2386

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Last Updated on August 24, 2020 by Marie Benz MD FAAD