(P17-012-23) Preschool Height as a Determinant of Young Adult Stature in Rural Nepal

Objectives: Differences in attained preschool length/height may forecast young adult stature. We tested this hypothesis in a population cohort in the rural Terai of Nepal.

Methods: We assessed height in a cohort of 1859 late adolescents/young adults (16-23 yr, “young adult”) in 2006-8 who received preschool anthropometry at enrollment into a vitamin A trial in Sept-Dec (preharvest) 1989 and remeasured ~16 mo later (Jan-Apr 1991, postharvest), comprising 52% of the trial exit cohort. Survivors not measured at follow-up were comparable to those analyzed w/r to preschool nutrition, morbidity and SES. By simple and multivariable models, we regressed young adult height on preschool length (L, cm) ( < 24 mo) or height (Ht, cm) (24-59 mo) and height-for-age z-score (HAZ). Results were stratified by sex and preschool age ( < 1, 1-2 and 3-4 yr), and coefficients tested against the null, b=0, adjusted for adolescent age (mo), caste (i.e., SES), preschool weight-for-height z-score and, in young women, time since menarche (in mo), marriage status and pregnancy history.

Results: At trial enrollment, mean (SD) L or Ht (HAZ) for girls/ boys at < 1, 1-2 and 3-4 yr was 60.5/62 cm (-1.3/-1.4), 75.6/77.9 cm (-2.5/-2.4) and 89.7/92.6 cm (-2.7/-2.3), respectively. Baseline, preharvest L or Ht was positively associated with young adult height. Adjusting for caste, preschool WHZ, time since menarche, marriage status and pregnancy history, young adult men were 0.20, 0.64 and 0.49 cm taller and women were 0.23, 0.64, 0.26 cm taller, respectively, per cm of preschool L or Ht (for each sex, p=0.02 for age < 1, p< 0.001 at older ages). Expressing attained growth as z-scores, young adult men and women were 2.43 and 2 cm taller, respectively, per one preschool HAZ-score increment (p < 0.001). Associations were stronger for postharvest preschool heights, representing a different year, season and more proximal measurement, with 3.47 and 2.76 cm increases in male and female young adult Ht, respectively, per one preschool HAZ-score increment. There was no effect of trial vitamin A-placebo supplementation on associations.

Conclusions: Taller preschoolers become taller adults. Average effect sizes may vary by sex, season, age of initial measure and length of follow-up interval, with height at 1-2 yr appearing most efficiently translated into young adult height. 

Funding Sources: USAID and Bill & Melinda Gates Foundation