The ubiquity and consequences of childhood growth stunting (<-2 SD in height-for-age Z score, HAZ) in rural areas of low-income nations has galvanized research into the reversibility of stunting, but the shortage of panel data has hindered progress. Using panel data from a native Amazonian society of foragers-farmers in Bolivia (Tsimane'), we estimate rates of catch-up growth for stunted children. One hundred forty-six girls and 158 boys 2 < or = age < or = 7 were measured annually during 2002-2006. Annual Delta height in cm and in HAZ were regressed separately against baseline stunting and control variables related to attributes of the child, mother, household, and village. Children stunted at baseline had catch-up growth rates 0.11 SD/year higher than their nonstunted age and sex peers, with a higher rate among children farther from towns. The rate of catch up did not differ by the child's sex. A 10% rise in household income and an additional younger sibling lowered by 0.16 SD/year and 0.53 SD/year the rate of growth. Results were weaker when measuring Delta height in cm rather than in HAZ. Possible reasons for catch-up growth include (a) omitted variable bias, (b) parental reallocation of resources to redress growth faltering, particularly if parents perceive the benefits of redressing growth faltering for child school achievement, and (c) developmental plasticity during this period when growth rates are most rapid and linear growth trajectories have not yet canalized.
Article Archive: Child
AIM: The study analysed variability in physical stature, weight, and body mass index (BMI) in the USA during 1971-2002.
SUBJECTS: Subjects were non-Hispanic Blacks and Whites, 2-74 years of age from the National Health and Nutrition Examination Surveys (NHANES I-III and 1999-2002).
METHODS: The coefficient of variation and the standard deviation of the logarithm of stature, weight, and BMI were used to assess anthropometric variability for groups defined by age, race, sex, income, and survey year. Weighted ordinary least squares regressions were used to estimate the effect of socio-economic variables on anthropometric variability.
RESULTS: (a) The relation between age and variability in weight or BMI resembles an inverted U, (b) men have lower variability in BMI than women, (c) Blacks and the poor have greater variability in weight and BMI than Whites or than the non-poor, and (d) variability in anthropometric indices increased during 1971-2002. Results were robust to the measure of variability used and to the use of the mean and mean square of the anthropometric indicators as explanatory variables.
CONCLUSION: Since anthropometric indices correlate reliably with canonical indicators of well-being (e.g. income), growing variability in anthropometric indices, particularly among the Blacks and the poor, signals growing inequality in quality of life--a worrisome trend.
Human indigenous circumpolar populations have elevated basal metabolic rates (BMRs) relative to predicted values; this metabolic elevation has been postulated to be a physiological adaptation to chronic and severe cold stress. The present study examines BMR in the Yakut, an indigenous high-latitude population from the Sakha Republic of Russia to determine (1) whether the Yakut show evidence of an elevated BMR, (2) if the Yakut display evidence of age-related changes in BMR, and (3) whether lifestyle differences influence BMR. BMR was measured during the late summer in 75 women and 50 men (ages 18-56 years) from the Siberian village of Berdygestiakh. Measured BMR (+/- SEM) of the entire sample was significantly elevated (+6.5%) compared to predictions based on body mass (6,623.7 +/- 94.9 vs. 6,218.2 +/- 84.7 kJ/day; P < 0.001). Additionally, measured BMR for the entire sample was significantly higher than predictions based on fat-free mass (+20.8%) and surface area (+8.9%). Males and females both showed significant elevations relative to all three standards. The elevated BMR of the Yakut does not appear to be attributable to extreme levels of protein, since the Yakut consume a mixed diet with a substantial proportion of carbohydrates. No significant age-related changes in BMR were found when controlled for body composition. No significant relationship was found between lifestyle variables and BMR, suggesting the possibility of a genetic or developmental mechanism. This study provides additional evidence of metabolic elevation in indigenous circumpolar groups and has important implications for estimating the nutritional requirements of these populations.
Researchers have shown interest in the relation between (a) social capital and individual income and (b) the individual health of people of industrial nations. The socioeconomic complexity of industrial nations makes it difficult to arrive at firm conclusions. We circumvent the obstacle by using data from a small-scale rural society of foragers-farmers in the Bolivian Amazon (Tsimane'). We examine the interactions between the outcome (BMI) and relative income, relative social capital, village income, and village social capital. We test three hypotheses: people in villages with more social capital should have higher BMI, the positive association between social capital and BMI will be more marked among the less well-off, and better-off people who display generosity will have higher BMI than better-off people who do not. On the methodological side we show the importance of: focusing on relative measures of income and social capital, estimating interaction between community and relative measures of income and social capital, and showing results through contour plots that summarize the relation between BMI and pairs of explanatory variables. On the substantive side we find evidence that village social capital and village income complement each other and are associated with higher BMI, the rich who are stingy have lower BMI than the rich who display generosity, and increase in village income might reduce individual incentives to invest in social capital. We explore interactions between explanatory variables and their influence on BMI, and end by recommending the use of an experimental research design to obtain unbiased estimates of causal effects.
Leptin is thought to signal energy stores, thus helping the body balance energy intake and expenditure. However, the strong relationship between leptin and adiposity in populations with adequate nutrition or common obesity is not universal across ecologic contexts, and leptin often correlates only weakly, or not at all, with adiposity in populations of lean or marginally-nourished males. To clarify whether the relationship between adiposity and leptin changes during development, this study examines leptin and body fat among children and adolescents of lowland Bolivia. Anthropometric measures of body composition and dried blood spot samples were collected from 487 Tsimane' ranging from 2 to 15 years of age. Leptin was assayed using an enzyme immunoassay protocol validated for use with blood spot samples. In this population, leptin concentrations were among the lowest reported in a human population (mean +/- SD: 1.26 +/- 0.5 and 0.57 +/- 0.3 in females and males). In addition, the relationship between leptin and adiposity follows distinct developmental trajectories in males and females. In males, leptin is weakly correlated with most measures of body composition at all ages investigated. However, in females, the level of body fat and the strength of the correlation between body fat and leptin (a measure of its strength as a signal of energy stores) both increase markedly with age. These findings suggest a more important role of leptin as a signal of energy stores among females as they approach reproductive maturity, while raising questions about the function of this hormone in lean males.
Culture is a critical determinant of human behavior and health, and the intergenerational transmission of knowledge regarding the use of available plant resources has historically been an essential function of culture. Local ethnobotanical knowledge is important for health and nutrition, particularly in rural low-resource settings, but cultural and economic transitions associated with globalization threaten such knowledge. This prospective study investigates the association between parental ethnobotanical knowledge and child health among the Tsimane', a horticulturalist and foraging society in Amazonian Bolivia. Anthropometric data and capillary blood samples were collected from 330 Tsimane' 2- to 10-year-olds, and mothers and fathers were interviewed to assess ethnobotanical knowledge and skills. Comprehensive measures of parental schooling, acculturation, and economic activities were also collected. Dependent variables included three measures of child health: (i) C-reactive protein, assayed in whole-blood spots as an indicator of immunostimulation; (ii) skinfold thickness, to estimate subcutaneous fat stores necessary to fuel growth and immune function; and (iii) height-for-age, to assess growth stunting. Each child health measure was associated with maternal ethnobotanical knowledge, independent of a wide range of potentially confounding variables. Each standard deviation of maternal ethnobotanical knowledge increased the likelihood of good child health by a factor of >1.5. Like many populations around the world, the Tsimane' are increasingly facing the challenges and opportunities of globalization. These results underscore the importance of local cultural factors to child health and document a potential cost if ethnobotanical knowledge is lost.
Infectious disease, such as diarrheal disease, respiratory infections, and parasitic infections, are an important source of nutritional and energetic stress in many populations. Inspired by the research and methodological innovations of A. Roberto Frisancho, this work considers the impact of childhood environment and local disease ecology on child health and nutritional patterns among an indigenous group in lowland Bolivia. Specifically, we examine the association between soil-transmitted helminth infection, especially hookworm species, and anthropometric markers of short- and long-term nutritional status. Fecal samples, anthropometric dimensions, and health interviews were collected for 92 children ranging in age from 2.0 to 10.9 years. Microscopic examination revealed high levels of parasitic infection, with 76% of children positive for hookworm species infections (77% of girls and 74% of boys). Less common infections included Ascaris lumbricoides, Trichurius trichiura, and Strongyloides stercoralis with only 15% of children positive for multiple-species infections. After adjusting for sex and age, no statistically significant associations were observed between helminth infections and the frequency of reported illness or anthropometric measures of nutritional status. These data demonstrate the difficulty of assessing nutritional impacts of endemic infections.
Immune function is a central component of maintenance effort, and it provides critical protection against the potentially life threatening effects of pathogens. However, immune defenses are energetically expensive, and the resources they consume are not available to support other activities related to growth and/or reproduction. In our study we use a life history theory framework to investigate tradeoffs between maintenance effort and growth among children in a remote area of Amazonian Bolivia. Baseline concentrations of C-reactive protein (CRP) were measured in 309 2- to 10-year olds as an indicator of immune activation, and height was measured at baseline and three months later. Elevated CRP at baseline predicts smaller gains in height over the subsequent three months, with the costs to growth particularly high for 2- to 4-year olds and for those with low energy reserves (in the form of body fat) at the time of immunostimulation. These results provide evidence for a significant tradeoff between investment in immunity and growth in humans, and highlight an important physiological mechanism through which maintenance effort may have lasting effects on child growth and development.
Infectious disease is a major global determinant of child morbidity and mortality, and energetic investment in immune defenses (even in the absence of overt disease) is an important life-history variable, with implications for human growth and development. This study uses a biomarker of immune activation (C-reactive protein) to investigate an important aspect of child health among the Tsimane', a relatively isolated Amerindian population in lowland Bolivia. Our objectives are twofold: 1) to describe the distribution of CRP by age and gender in a cross-sectional sample of 536 2-15-year-olds; and 2) to explore multiple measures of pathogen exposure, economic resources, and acculturation as predictors of increased CRP. The median blood-spot CRP concentration was 0.73 mg/l, with 12.9% of the sample having concentrations greater than 5 mg/L, indicating a relatively high degree of immune activation in this population. Age was the strongest predictor of CRP, with the highest concentrations found among younger individuals. Increased CRP was also associated with higher pathogen exposure, lower household economic resources, and increased maternal education and literacy. The measurement of CRP offers a direct, objective indicator of immune activation, and provides insights into a potentially important pathway through which environmental quality may shape child growth and health.
BACKGROUND: Global climate change and recent studies on early-life origins of well-being suggest that climate events early in life might affect health later in life.
AIM: The study tested hypotheses about the association between the level and variability of rain and temperature early in life on the height of children and adolescents in a foraging-farming society of native Amazonians in Bolivia (Tsimane'). SUBJECT AND METhods: Measurements were taken for 525 children aged 2-12 and 218 adolescents aged 13-23 in 13 villages in 2005. Log of standing height was regressed on mean annual level and mean intra-annual monthly coefficient of variation (CV) of rain and mean annual level of temperature during gestation, birth year, and ages 2-4. Controls include age, quinquennium and season of birth, parent's attributes, and dummy variables for surveyors and villages.
RESULTS: Climate variables were only related with the height of boys age 2-12. The level and CV of rain during birth year and the CV of rain and level of temperature during ages 2-4 were associated with taller stature. There were no secular changes in temperature (1973-2005) or rain (1943-2005).
CONCLUSION: The height of young females and males is well protected from climate events, but protection works less well for boys ages 2-12.
Recent research documents the effects of adverse conditions during gestation and early childhood on growth responses and health throughout life. Most research linking adverse conditions in early life with adult health comes from industrial nations. We know little about the plasticity of growth responses to environmental perturbations early in life among foragers and horticulturalists. Using 2005 data from 211 women and 215 men 20+ years of age from a foraging-horticultural society of native Amazonians in Bolivia (Tsimane'), we estimate the association between (a) adult height and (b) rainfall amount and variability during three stages in the life cycle: gestation (year 0), birth year (year 1), and years 2-5. We control for confounders such as height of the same-sex parent. Rainfall amount and variability during gestation and birth year bore weak associations with adult height, probably from the protective role of placental physiology and breastfeeding. However, rainfall variability during years 2-5 of life bore a negative association with adult female height. Among women, a 10% increase in the coefficient of variation of rainfall during years 2-5 was associated with 0.7-1.2% lower adult height (1.08-1.93 cm). Environmental perturbations that take place after the cessation of weaning seem to leave the strongest effect on adult height. We advance possible explanations for the absence of effects among males.
Among adults of industrial nations, growth stunting (<-2 SD height Z score) is associated with worse indicators of adult well-being (e.g., income). Does adult stunting also inflict private costs in traditional societies? Adult stunting penalties or height premiums might only emerge when traditional societies modernize. Here we estimate the association between adult stunting and indicators of adult well-being using data from a panel study in progress among the Tsimane', a foraging-farming society of native Amazonians in Bolivia. Subjects included 248 women and 255 men >or=age 22 measured annually during 5 consecutive years (2002-2006). Nine outcomes (wealth, monetary income, illness, access to credit, mirth, schooling, math skills, plant knowledge, forest clearance) were regressed separately against a stunting dummy variable and a wide range of control variables. We found no significant association between any of the indicators of own well-being and adult stunting. Additional analysis showed that stunting bore an association only with poorer mid-arm muscle area. Height premiums and stunting penalties, though evident and marked in modern societies, might not be common in all traditional societies.