The psychological distress of parents is associated with reduced linear growth of children: Evidence from a nationwide population survey.

BACKGROUND: Stunting, an indicator of restricted linear growth, has become a primary measure of childhood undernutrition due to its persistent high prevalence globally, and importance for health and development. Although the etiology is recognized as complex, most analyses have focused on social and biomedical determinants, with limited attention on psychological factors affecting care and nurturing in the home. We assessed whether the psychological distress of parents is related to child linear growth and stunting, and documented the associated risk factors, and examined the relationship between parental distress and behavioral and other risk factors for stunting. METHODS: We used data from the Indonesia National Health Survey 2013, including 46,315 children 6-59 months of age. Multivariate linear, logistic, and multilevel multinomial logistic regression, using survey weights, were used to assess the relationship between parental distress, as assessed by the WHO Self Reporting Questionnaire (SRQ20), with height-for-age z score (HAZ), stunting, and behavioral and other risk factors for stunting. RESULTS: Maternal, paternal and parental distress (i.e. both maternal and paternal distress) were associated with reduced linear growth of the children by 0.086 (95% CI -0.17, -0.00), 0.11 (95% CI -0.24, -0.02) and 0.19 (95% CI -0.37, -0.00) HAZ-scores, respectively. Maternal and paternal distress increased the risk of mild stunting (HAZ <-1) by 33% (95% CI 1.17,1.50) and 37% (95% CI 1.18,1.60), and the risk of moderate stunting (HAZ <-2) by 25% (95% CI 1.10,1.43) and 28% (95% CI 1.08,1.51]), respectively. Parental stress increased the risk of moderate stunting by 40% (95% CI 1.06,1.85). Amongst specific groups of risk factors, the proportion of HAZ-score lost was associated with socioeconomic factors (30.3%) including, low wealth, low maternal occupational status, low maternal education, rural residence, and low paternal occupational status; physiological factors (15.5%) including low maternal height, low maternal mid-upper arm circumference, being male, low paternal height; behavioral factors (8.9%) including open garbage disposal, paternal smoking, not using iodized salt; and experiencing at least one infectious diseases episode (1.1%). CONCLUSIONS: Maternal, paternal and parental stress were associated with reduced linear growth of children. These findings highlight the complex etiology of stunting and suggest nutritional and other biomedical interventions are insufficient, and that promotion of mental and behavioral health programs for parents must be pursued as part of a comprehensive strategy to enhance child growth and development, i.e. improved caretaker capacity, integrated community development, improved parenting skills, as well as reduced gender discrimination, and domestic violence.

ANTHROPOMETRIC AND DIETARY ASSESSMENT OF PATIENTS WITH GLYCOGENOSIS TYPE I.

OBJECTIVE: To perform anthropometric and dietary evaluation of patients with glycogenosis type Ia and Ib. METHODS: This cross-sectional study is composed of a sample of 11 patients with glycogenosis divided into two subgroups according to the classification of glycogenosis (type Ia=5 and type Ib=6), aged between 4 and 20 years. The analyzed anthropometric variables were weight, height, body mass index, and measures of lean and fat body mass, which were compared with reference values. For dietary assessment, a food frequency questionnaire was used to calculate energy and macronutrients intake as well as the amount of raw cornstarch consumed. Mann-Whitney U test and Fisher's exact test were performed, considering a significance level of 5%. RESULTS: Patients ingested raw cornstarch in the amount of 0.49 to 1.34 g/kg/dose at a frequency of six times a day, which is lower than recommended (1.75-2.50 g/kg/dose, four times a day). The amount of energy intake was, on average, 50% higher than energy requirements; however, carbohydrate intake was below the adequacy percentage in 5/11 patients. Short stature was found in 4/10 patients; obesity, in 3/11; and muscle mass deficit, in 7/11. There were no statistical differences between the subgroups. CONCLUSIONS: In patients with glycogenosis type I, there was deficit in growth and muscle mass, but no differences were found between the subgroups (Ia and Ib). Although the diet did not exceed the adequacy of carbohydrates, about 1/3 of the patients presented obesity, probably due to higher energy intake.

Gender inequality and sexual height dimorphism in Chile.

Chile has experienced significant improvements in its economy; thus, a secular trend in height has been observed in its population. Gender equality has also improved hand in hand with active policies addressing the gender gap in several dimensions (work, education, health) and overall economic improvement. This study examined changes in sexual height dimorphism in four samples of Chilean male and female working-age subjects and attempted to establish associations with gender equality and welfare. Sexual height dimorphism was calculated and compared with gender equality and overall welfare indicators between 1955 and 1995. Sexual height dimorphism reduction was seen to be strongly associated with greater gender equality and some general welfare indicators, such as the infant mortality rate. Gross domestic product per capita was not associated with sexual height dimorphism, but it showed significant associations with gender equality indicators. Overall, the gender gap has been reduced in Chile, which can be observed through improvements in gender equality indicators and a reduction in height dimorphism, mainly in areas associated with women's health. However, gender equality is still far behind in terms of female labour participation and women in political power, which require attention and further improvements.

Prospective Longitudinal Assessment of Linear Growth and Adult Height in Female Adolescents With Anorexia Nervosa.

CONTEXT: Growth retardation is an established complication of anorexia nervosa (AN); however, findings concerning the adult height of AN patients are inconsistent. OBJECTIVE: The objective of this work was to assess linear growth and adult height in female adolescents with AN. DESIGN AND SETTING: A prospective observational study was conducted in a tertiary university hospital. PARTICIPANTS: Participants included all 255 female adolescent AN patients hospitalized in the pediatric psychosomatic department between January 1, 2000 and May 31, 2015. INTERVENTIONS: Height and weight were assessed at admission and during hospitalization. Patients were subsequently invited for measurement of adult height. Additional data collected included premorbid height data, menstrual history, skeletal age, pertinent laboratory studies, and parental heights. MAIN OUTCOME MEASURE: The main outcome measure of this study was adult height. RESULTS: Mean age at admission was 15.4 ±â€…1.75 years, mean body mass index (BMI) was 15.7 ±â€…1.8 kg/m2 (BMI SDS = -2.3 ±â€…1.45 kg/m2). Premorbid height SD scores (SDS) were not significantly different from those expected in normal adolescents (0.005 ±â€…0.96). However, height SDS at admission (-0.36 ±â€…0.99), discharge (-0.34 ±â€…0.96), and at adult height (-0.29 ±â€…0.95), were significantly (P < .001) lower than expected. Furthermore, adult height was significantly (P = .006) shorter compared to the midparental target height. Stepwise forward linear regression analysis identified age (r = 0.32, P = .002) and bone age (r = -0.29, P = .006) on admission, linear growth during hospitalization (r = 0.47, P < .001), and change in luteinizing hormone during hospitalization (r = -0.265, P = .021) as independent predictors of improvement in height SDS from the time of admission to adult height. CONCLUSIONS: Whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.

Anthropometric and dietary assessment of patients with glycogenosis type i / Avaliação antropométrica e dietética de pacientes com glicogenose tipo i

ABSTRACT Objective: To perform anthropometric and dietary evaluation of patients with glycogenosis type Ia and Ib. Methods: This cross-sectional study is composed of a sample of 11 patients with glycogenosis divided into two subgroups according to the classification of glycogenosis (type Ia=5 and type Ib=6), aged between 4 and 20 years. The analyzed anthropometric variables were weight, height, body mass index, and measures of lean and fat body mass, which were compared with reference values. For dietary assessment, a food frequency questionnaire was used to calculate energy and macronutrients intake as well as the amount of raw cornstarch consumed. Mann-Whitney U test and Fisher's exact test were performed, considering a significance level of 5%. Results: Patients ingested raw cornstarch in the amount of 0.49 to 1.34 g/kg/dose at a frequency of six times a day, which is lower than recommended (1.75-2.50 g/kg/dose, four times a day). The amount of energy intake was, on average, 50% higher than energy requirements; however, carbohydrate intake was below the adequacy percentage in 5/11 patients. Short stature was found in 4/10 patients; obesity, in 3/11; and muscle mass deficit, in 7/11. There were no statistical differences between the subgroups. Conclusions: In patients with glycogenosis type I, there was deficit in growth and muscle mass, but no differences were found between the subgroups (Ia and Ib). Although the diet did not exceed the adequacy of carbohydrates, about 1/3 of the patients presented obesity, probably due to higher energy intake.

RESUMO Objetivo: Realizar avaliação antropométrica e dietética de pacientes com glicogenose tipos Ia e Ib. Métodos: Estudo transversal composto de uma amostra de 11 pacientes com glicogenose divididos em dois subgrupos de acordo com a classificação da glicogenose (tipo Ia=5; tipo Ib=6), com idades entre 4 e 20 anos. As variáveis antropométricas analisadas foram peso, estatura, índice de massa corporal e medidas de massa magra e gorda, que foram comparadas com valores de referência. Para avaliação dietética, foi utilizado um questionário de frequência alimentar para cálculo de ingestão de energia e macronutrientes, além da quantidade de amido cru ingerida. Realizaram-se testes U de Mann-Whitney e exato de Fisher, com nível de significância de 5%. Resultados: Os pacientes ingeriram amido cru na quantidade de 0,49 a 1,34 g/kg/dose na frequência de seis vezes ao dia, inferior à dosagem preconizada (1,75-2,50 g/kg/dose quatro vezes ao dia). A quantidade de energia consumida foi, em média, 50% a mais que as necessidades, contudo o consumo de carboidratos foi abaixo da porcentagem de adequação em 5/11 pacientes. Baixa estatura ocorreu em 4/10 pacientes, obesidade em 3/11 e déficit de massa muscular em 7/11. Não houve diferença estatística entre os subgrupos. Conclusões: Em pacientes com glicogenose tipo I, houve déficit de crescimento e de massa muscular, mas não diferença significante entre os subgrupos (Ia e Ib). Embora a dieta não tenha ultrapassado a adequação de carboidratos, 1/3 dos pacientes apresentou obesidade, provavelmente pela maior ingestão de energia.

Static balance assessment in patients with severe osteoarthritis of the knee.

BACKGROUND: Pain related to severe knee osteoarthritis may lead to static balance disorders. Patients with severe knee arthrosis with arthroplasty indication should be aware of the postoperative rehabilitation menu because their balance ability has decreased. METHODS: The study involved 33 patients with unilateral severe osteoarthritis (the study group) and 33 healthy subjects (the control group). We conducted the measurements of static balance with the CQStab2P platform. Functional disability was assessed using the Knee Society Score (KSS). RESULTS: In the study group, balance distribution asymmetry between lower limbs was higher. Patients unloaded the painful joints due to pain and knee instability. We observed statistically significant differences both with eyes open and with eyes closed only for balance symmetry. The study group had mean results of 53.9 (±19.1 SD) points in the KSS scales and 52.1 (±24.1) in the KSS function. There were statistically significant positive correlations regarding KSS and body height (0.270; P < 0.05), and negative correlations for body mass index (0.329; P < 0.01). In measurements with open eyes, patients' KSS correlated with mean amplitude of sways (-0,227; P < 0.01) and max anteroposterior (-0.279; P < 0.01). In measurements with eyes closed, KSS function correlated with number of sways in the sagittal plane (0.331; P < 0.01). CONCLUSIONS: Patients with severe osteoarthritis suffered from balance disorders regarding limbs' asymmetrical loading both under visual control and without visual control.

[Recommendations for the assessment of birth size and postnatal growth of preterm newborns]. / Recomendaciones para la evaluación del tamaño al nacer y del crecimiento posnatal de los recién nacidos prematuros.

It is unquestionable the need to have standards of size at birth and growth to evaluate and contribute to guide the actions in the care of the newborn. For many years the references of Lejarraga and Fustiñana were used, progressively replaced by those of Fenton and Kim. However, recently, the INTERGROWTH-21st project has developed prescriptive growth standards to evaluate the size at birth from 33 weeks of gestational age, references from 24 to 32.6 weeks of gestational age, and curves for postnatal growth from 27 weeks of gestational age onward. The Growth and Development and Neonatal Fetal Studies Committees of the Argentine Society of Pediatrics in conjunction with the Secretary of National Government of Health agreed to recommend the replacement of the Fenton and Kim curves with those of INTERGROWTH-21st.

Es innegable la necesidad de contar con curvas estándar de tamaño al nacer y crecimiento para evaluar y contribuir a orientar las acciones en la atención del neonato. Durante muchos años, se utilizaron las referencias de Lejarraga y Fustiñana, que fueron progresivamente reemplazadas por las de Fenton y Kim. Recientemente, el proyecto INTERGROWTH-21st construyó estándares de crecimiento prescriptivo para evaluar el tamaño al nacer desde las 33 semanas de edad gestacional, referencias para evaluar el tamaño al nacer desde las 24 a las 32,6 semanas de edad gestacional y curvas para el seguimiento longitudinal del crecimiento de recién nacidos pretérmino desde las 27 semanas de edad gestacional. Los Comités de Crecimiento y Desarrollo y de Estudios Feto-neonatales de la Sociedad Argentina de Pediatría, en conjunto con la Secretaría de Gobierno de Salud de la Nación, acordaron recomendar el reemplazo de las curvas de Fenton y Kim por las de INTERGROWTH-21st.

Weight and economic development: current net nutrition in the late 19th- and early 20th-century United States.

When traditional measures for material and economic welfare are scarce or unreliable, height and the body mass index (BMI) are now widely accepted measures that represent cumulative and current net nutrition in development studies. However, as the ratio of weight to height, BMI does not fully isolate the effects of current net nutrition. After controlling for height as a measure for current net nutrition, this study uses the weight of a sample of international men in US prisons. Throughout the late 19th- and early-20th centuries, individuals with darker complexions had greater weights than individuals with fairer complexions. Mexican and Asian populations in the US had lower weights and reached shorter statures. Black and white weights stagnated throughout the late 19th- and early-20th centuries. Agricultural workers' had greater weights than workers in other occupations.

Linear Growth between Early and Late Childhood and Cognitive Outcomes at 6-9 Years of Age.

OBJECTIVES: To assess the extent to which linear growth beyond the early years of life determines later cognitive development. STUDY DESIGN: We revisited children from New Delhi, India, who had participated in a randomized controlled trial 6 years before and assessed neurodevelopment using standardized and validated psychometric tools (Wechsler Intelligence Scale for Children, 4th edition; Crichton Vocabulary Scales; and Neuropsychological test battery). The associations of change in height for age z scores between early (12-36 months) and late (6-9 years) childhood with cognitive outcomes at 6-9 years of age were explored using linear regression models, after adjustment for appropriate confounders. RESULTS: Out of the 1000 North Indian children who were enrolled in the original study, 791 consented to participate in this follow-up. Height for age z scores in the first 2 years of life was significantly associated with both the Wechsler Intelligence Scale for Children-Crichton Vocabulary Scales (standardized ß coefficient [ß], 0.15; 95% CI, 0.08-0.23), and the Neuropsychological test battery-II z-score (ß, 0.09; 95% CI, 0.03-0.18) at 6-9 years of age. There were no significant associations between change in height for age z scores between early and later childhood and Wechsler Intelligence Scale for Children-Crichton Vocabulary Scales (ß, -0.03; 95% CI, -0.11 to 0.04) or Neuropsychological test battery-II z-scores (ß, -0.04; 95% CI, -0.12 to 0.06). CONCLUSIONS: Linear growth between early and late childhood is not associated with later cognitive outcomes. Our findings support the current practice of investing public health efforts to accelerate linear growth in the first 2-3 years of life.

Nutritional and socio-economic predictors of adult height in 152 world populations.

Height is one of the most sensitive indicators of well-being because it combines the external influences of nutrition, economic wealth, health care, social equality, and other important socio-economic factors. The aim of this ecological study was to compare actual values of male and female height from 152 populations (except sub-Saharan Africa) with the mean supply of 47 food items from the FAOSTAT database (1995-2013) and mean values of seven socio-economic indicators (1995-2013). This comparison shows that economic wealth at the country level is only a mediocre correlate of physical growth because it is only loosely associated with the quality of nutrition and it does not reflect the social distribution of wealth. In a multiple regression model, the best predictors of stature are protein sources of the best and worst quality, and total fertility (which critically influences the amount of resources expended per child). In summary, these findings indicate that irrespective of crude economic statistics, the choice of specific nutrient sources and small family size are crucial factors determining the optimal physical development of children. Based on our data, we also believe that current international dietary recommendations regarding protein intake and protein quality would deserve serious re-evaluation.

Assessment of Selected Anthropometric Parameters Influence on Balance Parameters in Children.

BACKGROUND AND OBJECTIVES: Balance is the ability of an organism to maintain its position in space. Balance disorders in children can lead to injuries and limited physical activity. Balance maintenance changes throughout puberty as well as in response to external factors. The study aimed to evaluate the influence of anthropometric parameters on balance in children aged 10 to 13 years. MATERIALS AND METHODS: 308 children were accessed to eligibility to participate in the study. After considering the inclusion and exclusion criteria the study included 223 participants (123 boys and 100 girls) aged 10 to 13 from elementary schools in Szczecin. The stabilometry of examineted children was performed using the SIGMA balance platform. RESULTS: It was shown that the balance parameters in children aged 10 to 13 worsen with increasing body mass and height, and do not correlate with age. CONCLUSION: Rapid diagnosis and identification of postural disorders in children make it possible to start targeted physical exercises and to make the therapeutic process more effective and complex. Future research is needed to obtain more data and draw conclusions crucial for physiotherapy practice.

People Are Taller in Countries With Better Environmental Conditions.

Background: Height is considered an indicator of health and well-being of an individual and population. Height variation results from a complex interaction of genetic, environmental, socioeconomic, and cultural influences. In order to understand the contribution of environmental stress associated with the child's growth, we correlated indicators of a stressful environment with adult height. Methods: We utilized seven equally weighted indicators of a stressful environment: homicide rates, GDP per capita, income inequality (GINI index), corruption perception index (CPI), unemployment rate, urban air pollution, and life expectancy (LE). Data on male and female height by country from 1992 to 1996 were obtained from the NCD Risk Factor Collaboration dataset. We assessed separately data from the 31 member countries of the Organization for Economic Co-operation and Development (OECD). In order to establish whether the indicators reflected a single conceptual dimension, we conducted an exploratory analysis and principal component analysis (PCA) with orthogonal transformation of the original variables. The relationships between male and female heights and the z-transformed principal components: Quality of life (QoL) and the Social factor (SF) that were derived after the PCA was assessed. Results: Male and female heights strongly correlated (p < 0.0001) with each of the seven indicators. In the PCA, the indicators clustered into "Quality of Life" factors (QoL), which comprised the CPI, GDP, air pollution, LE, and "Social factors" (SF), which comprised homicide rate and GINI index. For males and females, the average height by country strongly correlated with QoL (p < 0.0001) and SF (p < 0.0001). Within OECD countries, male and female height strongly and negatively correlated with the SF, but not with QoL. Conclusion: Growth attenuation is a tradeoff adaptive response: a calorie used for growth cannot be used for fighting stress. Here we show that: (1) Adult height, when used as a measure of child's growth, is an indicator of a stressful environment in context with the genetic background and spatial factors; (2) Stressful QoL factors and the SF exert a greater effect on men's height than women's height; and (3) The ranking of the indicators of short stature are income inequality > air pollution > GDP > CPI > homicide rate > LE > unemployment.

Height shrinkage, health and mortality among older adults: Evidence from Indonesia.

In this paper, we analyze the correlates of height shrinkage and the association of height shrinkage and late-life health among mid-aged and older adults from the Indonesian Family Life Survey. We first document the extent of height shrinkage based on measured height over 17 years. Height shrinkage is higher among older age groups, taller individuals, and women. Socioeconomic and initial health correlates of shrinkage are found to be different for men and women. Higher education, marital status, household consumption, urban birth and poor self-reported health in adulthood and childhood are found to be significant correlates for men. Ethnicity, working in the agricultural sector and availability of local health infrastructure are key correlates of height shrinkage for women. Height shrinkage of 1 cm is associated with a 0.02 s.d. decrease in cognition scores for Indonesian men and a 0.01 s.d. decrease for women, and 4% increase in index of mobility difficulties for both men and women. Extreme height loss, defined as height loss greater than 3 cm is associated with 8-10 percent lower lung function and grip strength among both men and women. Extreme height loss among Indonesian older women is also associated with a 7-percentage-point increase in the likelihood of death in the most recent wave. Our results emphasize the importance of taking into account age related height loss as a significant covariate for health and mortality of older adults, independent of baseline height and health.

Relating anthropometric indicators to brain structure in 2-month-old Bangladeshi infants growing up in poverty: A pilot study.

Anthropometric indicators, including stunting, underweight, and wasting, have previously been associated with poor neurocognitive outcomes. This link may exist because malnutrition and infection, which are known to affect height and weight, also impact brain structure according to animal models. However, a relationship between anthropometric indicators and brain structural measures has not been tested yet, perhaps because stunting, underweight, and wasting are uncommon in higher-resource settings. Further, with diminished anthropometric growth prevalent in low-resource settings, where biological and psychosocial hazards are most severe, one might expect additional links between measures of poverty, anthropometry, and brain structure. To begin to examine these relationships, we conducted an MRI study in 2-3-month-old infants growing up in the extremely impoverished urban setting of Dhaka, Bangladesh. The sample size was relatively small because the challenges of investigating infant brain structure in a low-resource setting needed to be realized and resolved before introducing a larger cohort. Initially, fifty-four infants underwent T1 sequences using 3T MRI, and resulting structural images were segmented into gray and white matter maps, which were carefully evaluated for accurate tissue labeling by a pediatric neuroradiologist. Gray and white matter volumes from 29 infants (79 â€‹± â€‹10 days-of-age; F/M â€‹= â€‹12/17), whose segmentations were of relatively high quality, were submitted to semi-partial correlation analyses with stunting, underweight, and wasting, which were measured using height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) scores. Positive semi-partial correlations (after adjusting for chronological age and sex and correcting for multiple comparisons) were observed between white matter volume and HAZ and WAZ; however, WHZ was not correlated with any measure of brain volume. No associations were observed between income-to-needs or maternal education and brain volumetric measures, suggesting that measures of poverty were not associated with total brain tissue volume in this sample. Overall, these results provide the first link between diminished anthropometric growth and white matter volume in infancy. Challenges of conducting a developmental neuroimaging study in a low-resource country are also described.

Social class-specific secular trends in height among 19-year old Polish men: 6th national surveys from 1965 till 2010.

The results presented in this study concern the assessment of the secular trend of body height in 10 % a random national sample (N = 134,224) representing all regions of Poland in 8 homogeneous social groups over 45 years in Poland (1965-2010). Very significant political, social and economic changes in Poland occurred in the period studied. The political revolution that began in Poland at the turn of the 1980s and 1990s dramatically changed the picture of social inequalities in the country. It rapidly transformed (in different directions and to a different degree) the economic situation, working conditions, lifestyles and the prestige of particular social classes and professional groups. A positive secular trend was observed in 19-year-old participants in the period analysed in all homogeneous socio-professional groups, however, with different intensity in each group. The highest body height increases in 1965-2010 were observed in the sons of farmers with post-primary father's education (7.77 cm). The lowest were observed among the sons of professionals, only 5.45 cm. Although social distances between extreme socio-economic groups significantly decreased (from 4.89 cm in 1965 to 2.76 cm in 2010), social gradients of body height, despite the improvement in the standards of living of the entire society remained exceptionally stable and unchanged for nearly half a century.

Stature and education among Roma women: taller stature is associated with better educational and economic outcomes.

The association between body height and educational outcome, as measured by years of completed schooling, was investigated among Roma women in Serbia in 2014-2018. Height, demographic data, level of schooling and reproductive histories were collected from 691 Roma women aged between 16 and 80 years living in rural settlements in central and western Serbia. Multinomial logistic regression analysis showed that short stature was associated with an increased risk of low education, possibly as a result of poor growth and developmental disadvantage in early life. Roma cultural practices were also shown to influence the school achievement of these Roma girls: in addition to height, education was positively associated with a higher bride price and better socioeconomic status, as acquired through marriage. For Roma women, height might influence not only their level of education but also their lifetime prospects.

Abnormal linear growth in paediatric adrenal diseases: Pathogenesis, prevalence and management.

Abnormal adrenal function can interfere with linear growth, potentially causing either acceleration or impairment of growth in paediatric patients. These abnormalities can be caused by direct effects of adrenal hormones, particularly glucocorticoids and sex steroids, or be mediated by indirect mechanisms such as the disturbance of the growth hormone-insulin-like growth factor-1 axis and aromatization of androgens to oestrogens. The early diagnosis and optimal treatment of adrenal disorders can prevent or minimize growth disturbance and facilitate improved height gain. Mechanisms of growth disturbance in the following abnormal states will be discussed; hypercortisolaemia, hyperandrogenaemia and obesity. Prevalence and features of growth disturbance will be discussed in ACTH-dependent and ACTH-independent Cushing's syndrome, adrenocortical tumours, premature adrenarche, congenital adrenal hyperplasia and adrenal insufficiency disorders. Recommendations for management have been included.

Rojiroti microfinance and child nutrition: a cluster randomised trial.

OBJECTIVE: To determine whether Rojiroti microfinance, for poor Indian women, improves child nutrition. DESIGN: Cluster randomised trial. SETTING: Tolas (village communities) in Bihar State. PARTICIPANTS: Women and children under 5 years. INTERVENTIONS: With Rojiroti microfinance, women form self-help groups and save their money to provide loans to group members. After 6 months, they receive larger external loans. Tolas were randomised to receive Rojiroti immediately or after 18 months. OUTCOME MEASURES: The primary analysis compared the mean weight for height Z score (WHZ) of children under 5 years in the intervention versus control tolas who attended for weight and height measurement 18 months after randomisation. Secondary outcomes were weight for age Z score (WAZ), height for age Z score, mid-upper arm circumference (MUAC), wasting, underweight and stunting. RESULTS: We randomised 28 tolas to each arm and collected data from 2469 children (1560 mothers) at baseline and 2064 children (1326 mothers) at follow-up. WHZ was calculated for 1718 children at baseline and 1377 (674 intervention and 703 control) at follow-up. At 18 months, mean WHZ was significantly higher for intervention (-1.02) versus controls (-1.37; regression coefficient adjusted for clustering ß=0.38, 95% CI 0.16 to 0.61, p=0.001). Significantly fewer children were wasted in the intervention group (122, 18%) versus control (200, 29%; OR=0.46, 95% CI 0.28 to 0.74, p=0.002). Mean WAZ was better in the intervention group (-2.13 vs -2.37; ß=0.27, 95% CI 0.11 to 0.43, p=0.001) as was MUAC (13.6 cm vs 13.4 cm; ß=0.22, 95% CI 0.03 to 0.40, p=0.02). In an analysis adjusting for baseline nutritional measures (259 intervention children and 300 control), only WAZ and % underweight showed significant differences in favour of the intervention. CONCLUSION: In marginalised communities in rural India, child nutrition was better in those who received Rojiroti microfinance, compared with controls. TRIAL REGISTRATION NUMBER: NCT01845545.

Which modifiable prenatal factors mediate the relation between socio-economic position and a child's weight and length at birth?

Although several studies have shown a positive association between socio-economic position and size at birth, not enough is known about the modifiable factors that may be involved. We aimed to investigate whether maternal prepregnancy body mass index (BMI), smoking, diet, and depression during pregnancy mediate the positive association between maternal education and birth size. Weight and length z-scores specific for gestational age and sex were calculated for 1,500 children from the EDEN mother-child cohort. A mediation analysis of the associations between maternal education and birth size was conducted with a counterfactual method, adjusted for recruitment centre, parity, maternal height, and age. In the comparison of children of mothers with low versus intermediate education levels, maternal smoking during pregnancy explained 52% of the total effect of education on birth weight. Similar findings were observed with birth length z-score (37%). The comparison of children of mothers with high versus intermediate education levels yielded a non-significant total effect, which masked opposite mediating effects by maternal BMI and smoking during pregnancy on both birth weight and length. Prepregnancy BMI and maternal smoking during pregnancy mediate the positive association between maternal education and birth weight and length z-scores. These mediators, however, act in opposite directions, thereby masking the extent to which healthy prenatal growth is socially differentiated.

Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990-2011.

OBJECTIVE: Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. METHODS: Data were drawn from three national examination surveys conducted in 1990-1992, 1997-1999 and 2008-2011 (n = 18,541; age range: 25-69 years). Obesity was defined by a body mass index ≥30 kg/m2 using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. RESULTS: In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01-1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05-0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19-1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI -0.27 to 0.92, p = 0.283). CONCLUSIONS: These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.