Socioeconomic impacts on Andean adolescents' growth: Variation between households, between communities and over time

Abstract

Background/objectives: We evaluated potential socioeconomic contributors to variation in Andean adolescents' growth between households within a peri-urban community undergoing rapid demographic and economic change, between different community types (rural, peri-urban, urban) and over time. Because growth monitoring is widely used for assessing community needs and progress, we compared the prevalences of stunting, underweight, and overweight estimated by three different growth references.

Methods: Anthropometrics of 101 El Alto, Bolivia, adolescents (Alteños), 11.0-14.9 years old in 2003, were compared between households (economic status assessed by parental occupations); to one urban and two rural samples collected in 1983/1998/1977, respectively; and to the WHO growth reference, a representative sample of Bolivian children (MESA), and a region-wide sample of high-altitude Peruvian children (Puno).

Results: Female Alteños' growth was positively associated with household and maternal income indices. Alteños' height averaged ∼0.8SD/∼0.6SD/∼2SDs greater than adolescents' height in urban and rural communities measured in 1983/1998/1977, respectively. Overweight prevalence was comparable to the WHO, and lower than MESA and Puno, references. Stunting was 8.5/2.5/0.5 times WHO/MESA/Puno samples, respectively.

Conclusions/implications: Both peri-urban conditions and temporal trends contributed to gains in Alteños' growth. Rural out-migration can alleviate migrants' poverty, partly because of more diverse economic options in urbanized communities, especially for women. Nonetheless, Alteños averaged below WHO and MESA height and weight medians. Evolved biological adaptations to environmental challenges, and the consequent variability in growth trajectories, favor using multiple growth references. Growth monitoring should be informed by community- and household-level studies to detect and understand local factors causing or alleviating health disparities.

Keywords: adolescent growth; children's growth references; double burden of malnutrition; health disparities; high-altitude adaptation; secular trend.

Figure 1.

Secular trends in height-for-age (HFA) z-score^w. z-score^w is calculated with respect to the WHO growth reference (see main text and Supplementary Data Section S7 for detailed explanation); mean HFA z-score^w is plotted for each of the seven samples examined in this article (symbol shape and size denote community type and altitude, respectively). Solid line depicts estimated urban HFA secular trend; dashed line indicates estimated rural HFA secular trend.