title: Gender perceptions predict sex differences in growth patterns of indigenous Guatemalan infants and young children.
abstract: BACKGROUND
  Nearly one-half of Guatemalan children experience growth faltering, more so in indigenous than in nonindigenous children.
  
  
  OBJECTIVE
  On the basis of ethnographic interviews in Totonicapán, Guatemala, which revealed differences in maternal perceptions about food needs in infant girls and boys, we predicted a cumulative sex difference in favor of girls that occurred at ∼6 mo of age and diminished markedly thereafter. We examined whether the predicted differences in age-sex patterns were observed in the village, replicated the examination nationally for indigenous children, and examined whether the pattern in nonindigenous children was different.
  
  
  METHODS
  Ethnographic interviews (n = 24) in an indigenous village were conducted. Anthropometric measurements of the village children aged 0-35 mo (n = 119) were obtained. National-level growth patterns were analyzed for indigenous (n = 969) and nonindigenous (n = 1374) children aged 0-35 mo with the use of Demographic and Health Survey (DHS) data.
  
  
  RESULTS
  Mothers reported that, compared with female infants, male infants were hungrier, were not as satisfied with breastfeeding alone, and required earlier complementary feeding. An anthropometric analysis confirmed the prediction of healthier growth in indigenous girls than in indigenous boys throughout the first year of life, which resulted in a 2.98-cm height-for-age difference (HAD) between sexes in the village and a 1.61-cm HAD (P < 0.001) in the DHS data between 6 and 17 mo of age in favor of girls. In both data sets, the growth sex differences diminished in the second year of life (P < 0.05). No such pattern was seen in nonindigenous children.
  
  
  CONCLUSIONS
  We propose that the differences in the HAD that first favor girls and then favor boys in the indigenous growth patterns are due to feeding patterns on the basis of gendered cultural perceptions. Circumstances that result in differential sex growth patterns need to be elucidated, in particular the favorable growth in girls in the first year of life.
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland; and atumilowicz@gainhealth.org.
authors.forename: Alison
authors.identifier: http://orcid.org/0000-0002-8955-1479
authors.initials: A
authors.lastname: Tumilowicz
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Habicht
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY.
authors.forename: Gretel
authors.initials: G
authors.lastname: Pelto
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY.
authors.forename: David L
authors.initials: DL
authors.lastname: Pelletier
mesh_terms: D001827:Body Height; D002657:Child Development; D015362:Child Nutrition Disorders / Q000208:ethnology / Q000503:physiopathology*; D002675:Child, Preschool; D005008:Ethnopsychology / Q000379:methods; D005248:Feeding Methods / Q000009:adverse effects*; D005260:Female; D057238:Growth Charts; D006130:Growth Disorders / Q000208:ethnology / Q000209:etiology*; D006166:Guatemala; D006801:Humans; D007197:Indians, Central American / Q000523:psychology; D007223:Infant; D007228:Infant Nutrition Disorders / Q000208:ethnology / Q000503:physiopathology*; D007231:Infant, Newborn; D008297:Male; D009034:Mother-Child Relations / Q000208:ethnology; D012423:Rural Health / Q000208:ethnology; D012737:Sex Factors; D063507:Sexism / Q000208:ethnology
keywords: child growth; exclusive breastfeeding; gender; infant and young child feeding; sex