Modeling Growth Trajectories in Stunted Children Under 5 Years of Age: A Retrospective Analysis of Clinical Data from Guatemala

BackgroundStunting is a pervasive issue in low- and middle-income countries, particularly affecting rural and Indigenous populations. Little reported data is available on the growth of clinical populations of children with stunting, including those with more severe stunting.ObjectiveThis study examines growth trajectories of children under 5 years of age from a long-standing clinical care program to address childhood stunting that provides monthly at-home growth monitoring, family food rations, nutrition counseling, micronutrient supplementation, and childhood illness management.HypothesisWe hypothesized that children with stunting are a clinically heterogeneous group, where some experience ongoing growth failure and others catch-up growth.MethodsWe utilized data from 2827 children and 38 864 height measurements. We applied superimposition by translation and rotation modeling to characterize growth patterns.ResultsMedian age at first measurement was 9 months (IQR: 3, 16) and median length of growth monitoring was 17 months (IQR: 8, 30). Median height-for-age Z-score at first measurement was -2.51 (IQR: -3.23, -1.68). There was variability in growth dynamics, with some children showing potential catch-up growth, particularly those with the lowest initial height-for-age metrics. In regression analysis, factors significantly associated with growth improvement over time included greater initial severity of stunting, male sex, and geographical region.ConclusionsThese findings underscore the heterogeneity of growth responses among stunted children and the need for individualized intervention strategies. They emphasize the necessity for ongoing investigations of both tailored clinical interventions and novel factors associated with growth variability and catch-up growth.