title: Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala.
abstract: OBJECTIVE
  Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical 'under-5' stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49.8%), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1.5 months of life among Guatemalan infants.
  
  
  METHODS
  As part of a cross-sectional observational study, supine length was measured in young infants. Mothers' height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ <-2 using WHO growth standards.
  
  
  METHODS
  Eight rural, indigenous Mam-Mayan villages (n 200, 100% of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n 106, 27% of Mayan indigenous origin), Guatemala.
  
  
  METHODS
  Three hundred and six newborns with a median age of 19 d.
  
  
  RESULTS
  The median rural HAZ was -1.56 and prevalence of stunting was 38%; the respective urban values were -1.41 and 25%. Linear regression revealed no relationship between infant age and HAZ (r = 0.101, r(2) = 0.010, P = 0.077). Maternal height explained 3% of the variability in HAZ (r = 0.171, r(2) = 0.029, P = 0.003).
  
  
  CONCLUSIONS
  Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.
authors.affiliation: 1Center for Studies of Sensory Impairment,Aging and Metabolism (CeSSIAM),17 Avenida # 16-89 (interior),Zona 11 (Anillo Periferico),Guatemala City 01011,Guatemala.
authors.forename: Noel W
authors.initials: NW
authors.lastname: Solomons
authors.affiliation: 1Center for Studies of Sensory Impairment,Aging and Metabolism (CeSSIAM),17 Avenida # 16-89 (interior),Zona 11 (Anillo Periferico),Guatemala City 01011,Guatemala.
authors.forename: Marieke
authors.initials: M
authors.lastname: Vossenaar
authors.affiliation: 2Institute of Parasitology and School of Dietetics of Human Nutrition,McGill University,Ste Anne de Bellevue,Quebec,Canada.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Chomat
authors.affiliation: 3Department of Health Sciences,Vrije Universeit,Amsterdam,The Netherlands.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Doak
authors.affiliation: 2Institute of Parasitology and School of Dietetics of Human Nutrition,McGill University,Ste Anne de Bellevue,Quebec,Canada.
authors.forename: Kristine G
authors.initials: KG
authors.lastname: Koski
authors.affiliation: 2Institute of Parasitology and School of Dietetics of Human Nutrition,McGill University,Ste Anne de Bellevue,Quebec,Canada.
authors.forename: Marilyn E
authors.initials: ME
authors.lastname: Scott
mesh_terms: D001827:Body Height / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000453:epidemiology* / Q000208:ethnology; D006128:Growth; D006130:Growth Disorders / Q000453:epidemiology* / Q000208:ethnology; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007197:Indians, Central American; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000208:ethnology; D039382:Maternal Nutritional Physiological Phenomena; D009035:Mothers; D015995:Prevalence; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population
keywords: Guatemala; Length-for-age; Linear growth; Stunting; Young infants