Early Childhood Height is a Determinant of Young Adult Stature in Rural Nepal

Abstract Background: Does preschool height predict adult stature in undernourished settings? The extent to which preschool length or height forecasts young adult stature is unclear in chronically undernourished populations. Methods: In 2006-8, we assessed height in a cohort of 1859 young adults, aged 16-23 years, in rural Nepal who, as preschoolers (<4 yr), were measured at baseline and again 16 months later during a vitamin A supplementation trial in 1989-91. We assessed by linear regression the ability of preschool length (L, measured <24 mo) or height (Ht, 24-59 mo), at each year of age to predict 16-23 year old height, adjusted for month of young adult age, interval duration (in months), caste, preschool weight-for-height z-score and, in young women, time since menarche, marriage status and pregnancy history. Results: Young women were a mean of 0.81, 1.15, 0.8, 0.23, 0.35 cm taller (all p<0.01) and young men, 0.85, 1.17, 0.69, 0.63 and 0.49 cm taller (all p<0.001) per cm of attained L/Ht at each successive preschool year of age and, overall, were 1.98 and 2.39 cm taller for each unit increase in preschool L/Ht z-score (L/HAZ) (both p<0.001). Coefficients were generally larger for 16-month follow-up measurements. Combining data from both early childhood assessments, the percent of young adult height attained by children with normal L/HAZ (>-1) increased from 38-40% mid-infancy to ~69-74% by 6 years of age. By 3-6 years of age heights of stunted children (L/HAZ<-2) were consistently ~4-7% lower in their young adult height versus normal statured children. There was no effect of preschool vitamin A receipt. Conclusions: Shorter young children become shorter adults but predictive effects can vary by sex, age assessed, and may be influenced by year or season of measurement.