title: Socioeconomic differences in childhood length/height trajectories in a middle-income country: a cohort study.
abstract: BACKGROUND
  Socioeconomic disadvantage is associated with shorter adult stature. Few studies have examined socioeconomic differences in stature from birth to childhood and the mechanisms involved, particularly in middle-income former Soviet settings.
  
  
  METHODS
  The sample included 12,463 Belarusian children (73% of the original cohort) born in 1996-1997, with up to 14 stature measurements from birth to 7 years. Linear spline multi-level models with 3 knots at 3, 12 and 34 months were used to analyse birth length and growth velocity during four age-periods by parental educational achievement (up to secondary school, advanced secondary/partial university, completed university) and occupation (manual, non-manual).
  
  
  RESULTS
  Girls born to the most (versus least) educated mothers were 0.43 cm (95% confidence interval (CI): 0.28, 0.58) longer at birth; for boys, the corresponding difference was 0.30 cm (95% CI: 0.15, 0.46). Similarly, children of the most educated mothers grew faster from birth-3 months and 12-34 months (p-values for trend ≤ 0.08), such that, by age 7 years, girls with the most (versus least) educated mothers were 1.92 cm (95% CI: 1.47, 2.36) taller; after controlling for urban/rural and East/West area of residence, this difference remained at 1.86 cm (95% CI: 1.42, 2.31), but after additionally controlling for mid-parental height, attenuated to 1.10 cm (95% CI: 0.69, 1.52). Among boys, these differences were 1.95 cm (95% CI: 1.53, 2.37), 1.89 cm (95% CI: 1.47, 2.31) and 1.16 cm (95% CI: 0.77, 1.55), respectively. Additionally controlling for breastfeeding, maternal smoking and older siblings did not substantively alter these findings. There was no evidence that the association of maternal educational attainment with growth differed in girls compared to boys (p for interaction = 0.45). Results were similar for those born to the most (versus least) educated fathers, or who had a parent with a non-manual (versus manual) occupation.
  
  
  CONCLUSIONS
  In Belarus, a middle-income former Soviet country, socioeconomic differences in offspring growth commence in the pre-natal period and generate up to approximately 2 cm difference in height at age 7 years. These associations are partly explained by genetic or other factors influencing parental stature.
  
  
  BACKGROUND
  Current Controlled Trials: NCT01352247 assigned 9 Sept 2005; ClinicalTrials.gov. Identifier: NCT01561612 received 20 Mar 2012.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. rita.patel@bristol.ac.uk.
authors.forename: Rita
authors.initials: R
authors.lastname: Patel
authors.forename: Kate
authors.initials: K
authors.lastname: Tilling
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Lawlor
authors.forename: Laura D
authors.initials: LD
authors.lastname: Howe
authors.forename: Natalia
authors.initials: N
authors.lastname: Bogdanovich
authors.forename: Lidia
authors.initials: L
authors.lastname: Matush
authors.forename: Emily
authors.initials: E
authors.lastname: Nicoli
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
authors.forename: Richard M
authors.initials: RM
authors.lastname: Martin
mesh_terms: D000328:Adult; D001827:Body Height; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006128:Growth; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009790:Occupations; D010290:Parents; D002094:Republic of Belarus; D012424:Rural Population; D012574:Schools; D012907:Smoking; D012959:Socioeconomic Factors; D014505:Urban Population