Lengths of stunted children are severely compromised, but breadths – not so much: Disproportions in the anthropometric deficits in so‐called “chronic malnutrition”
Authors: Shiu Kimberly , Solomons Noel W. , Liem Windy Mulia , García‐Meza Rosario 
Published: November 2023

Background

Failure to grow in length/height in relation to reference/standard growth curves and to fall below ‐2 SD of the median (stunting) has been termed “chronic malnutrition.” Evidence suggests, however, that this condition is more a selective affliction of impaired elongation of the long bones of the lower extremities than a generalized malnourishing process affecting the whole individual. Only a harmonic and proportional reduction in body size would justify the connotation of “malnutrition” in situations of linear stunting.

Objectives

To compare the relative deficits in longitudinal (length) vis‐ a‐vis circumferential (breadth) measurements and assess their interrelationships in underprivileged preschool children from stunting‐endemic zones of the Western Highlands of Guatemala.

Methods

212 preschool children aged 4 to 7 y were measured for height (without footwear and posture in the Frankfort plane with a wall stadiometer, in cm), weight (with daytime garb and without shoes and adjusting for clothing weight on a Rosthal EB9325 scale to the nearest 0.1 kg), head circumference (the maximal circumference with a SECA 212 tape measure, to nearest 0.1 cm), neck circumference (with a flexible metric tape, to 0.1 cm), and waist circumference (in expiration at the mid‐point of the lower rib and iliac crest with a flexible tape, in cm), this in 2 populations of suspected high prevalence of stunting (La Estancia, Quetzaltenango, n=75, and Santa María Chiquimula, Totonicipán, n=137) in the Western Highlands of Guatemala. Sagittal photographic images were taken with a visual marker tape on the iliac crest, allowing for assessment of the relative contribution of the trunk (crown to crest) and leg (crest to plantar surface of foot) to total height, with quantitative estimates derived in cm from the measured stature. Descriptive statistics (medians) and associated ratios were generated.

Results

Eighty‐seven (41%) were boys and 125 (59%) were girls, with a median age of 69 months. Median neck circumference (28.3 cm) proved to be ~48% of both head (median: 49.7 cm) and waist circumference (median: 49.8 cm), with the latter measures having a 1:1 ratio. The Spearman (rho) correlation coefficients were: 0.39 for head vs waist circumference; 0.46 for neck vs head; and 0.48 for neck vs waist. There was a significantly higher ratio of the neck‐to‐trunk (p=0.03) and waist‐to‐trunk (p=0.02), but not head‐to‐trunk (p=0.49) in the male subsample The paired inter‐site circumference ratios were generally unaffected by stunting. Median head circumference Z‐score (−0.65, CDC reference) was relatively preserved in relationship to the corresponding height‐for‐age Z‐score (−2.35, WHO standard).

Conclusion

While the stature of stunted and short‐stature preschool children is severely compromised, there is relative conservation of the head circumference. Neither international nor national references or standards exist as yet for head or waist circumference, such that the exploration of concurrent length and circumference measurements and interrelationshipa should be extended to healthy Guatemalan children of adequate stature.