Growth stunting and low height-for-age in the Yucatan Peninsula

Abstract

We critically analyze definitions of growth stunting and low height-for-age, focusing on the arbitrary cut-off points that classify people dichotomously as “stunted” or “non-stunted.” We discuss how individuals may be included or excluded in one of such categories, depending on the standard or references used, and list inherent health implications. We analyze data on prevalence and predictors of stunting among Maya children and adults in Yucatan, to highlight pros and cons of using dichotomized versus continuous height-for-age data. Stunting among Yucatecan Maya children has decreased since the 1990s (Azcorra et al., Growth status in children and adolescents in Yucatan, Mexico: a human ecology perspective. In: Studies in human ecology, House for Science and Technology, Ha Noi, p. 120-138, 2010) but prevalence of low height-for-age continues to be high, throughout the growing period (Méndez Domínguez, Aspectos del ambiente familiar y escolar relativos a los hábitos de alimentación y actividad física que se asocian al exceso de peso entre escolares de Mérida, Yucatán, 2013; Azcorra-Perez, Intergenerational factors that shape the nutritional status of urban Maya households in Merida, Mexico. A 3-generations study, 2014). Male and female adult Maya average stature has not changed in 100 years and remains extremely low (Steggerda, Maya Indians of Yucatan. Carnegie Institution of Washington, Washington, DC, 1941; McCullough, Am J Phys Anthropol 58:221-225, 1982; Dickinson et al., Estud Antropol Biol. 4:123-150, 1989; Varela-Silva et al., Coll Anthropol 36:39-45, 2012). Short stature has been associated with increased risk for cardiovascular diseases and other noncommunicable diseases and its effects seem to be potentiated by overweight/obesity (OW/OB). This is especially true among the Maya who also show an elevated accumulation of centralized fat. The association of being short in stature with being OW/OB produces negative health outcomes that are stronger and more pernicious than the ones seen in populations where only one of the conditions happens, in the absence of the other. We highlight some aspects that may help to answer the following questions: i) why is the prevalence of stunting decreasing among Maya children but the prevalence of low height-for-age during growing years remains high, and ii) why has the stature of the adult Maya remained unchangeable in the last century?.