title: Nutritional and health status of Tibetan children living at high altitudes.
abstract: BACKGROUND
  Children living at high altitudes often have delayed growth, but whether growth retardation is related to altitude or to other factors is not known.
  
  
  METHODS
  A multicultural health care team assessed 2078 Tibetan children 0 to 84 months of age for anthropometric and clinical signs of malnutrition. The children lived in 11 counties, which contained more than 50 diverse urban and nonurban (nomadic, agricultural, or periurban) communities in the Tibet Autonomous Region of China. The height and weight of the children were compared with those of U.S. children. Height and weight were expressed as z scores (the number of standard deviations from the median of the age- and sex-specific reference group).
  
  
  RESULTS
  The mean z score for height fell from -0.5 to -1.6 in the first 12 months of life and generally ranged from -2.0 to -2.4 in older children. Overall, of 2078 children, 1067 (51 percent) had moderately or severely stunted growth, as defined by a z score of -2.0 or lower. Of the 1556 children 24 months of age or older, 871 (56 percent) had stunted growth, which was severe (z score, -3.0 or lower) in 380 (24 percent). Among the children in this age group, 787 of the 1313 nonurban children (60 percent) had stunting, as compared with 84 of the 243 urban children (35 percent). Stunting was associated with clinical conditions such as rickets, abdominal distention, hair depigmentation, and skin lesions and with a maternal history of hepatitis or goiter. Stunting was not associated with altitude, after adjustment for the type of community.
  
  
  CONCLUSIONS
  In Tibetan children, severe stunting due to malnutrition occurs early in life, and morbidity is high.
authors.affiliation: Tibet Child Nutrition and Collaborative Health Project, Public Health Institute, Santa Cruz, Calif, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Harris
authors.forename: P B
authors.initials: PB
authors.lastname: Crawford
authors.forename: Y
authors.initials: Y
authors.lastname: Yangzom
authors.forename: L
authors.initials: L
authors.lastname: Pinzo
authors.forename: P
authors.initials: P
authors.lastname: Gyaltsen
authors.forename: M
authors.initials: M
authors.lastname: Hudes
mesh_terms: D000531:Altitude; D000886:Anthropometry; D001827:Body Height; D001835:Body Weight; D002648:Child; D015362:Child Nutrition Disorders / Q000150:complications / Q000453:epidemiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology*; D006304:Health Status; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D009752:Nutritional Status; D015995:Prevalence; D012016:Reference Values; D018609:Tibet / Q000453:epidemiology