Mohammad I. El Mouzan|Abdullah S. Al Herbish|Abdullah A. Al Salloum|Peter Foster|Ahmad Al Omer|Mansour M. Qurachi
Prevalence of short stature in Saudi children and adolescents
King Saud University|University of Manchester|King Saud University|University of Manchester|King Saud Medical City|Al Yamamah University
original articleprevalence short stature saudi children adolescents mohammad el mouzan abdullah al herbish abdullah al salloum peter j foster ahmad al omer mansour qurachi mohammad el mouzan department pediatrics king saud university riyadh saudi arabia abdullah al herbish school mathematics manchester university united kingdom abdullah al salloum department pediatrics king saud university riyadh saudi arabia peter j foster school mathematics manchester university united kingdom ahmad al omer childrens hospital king saud medical complex riyadh saudi arabia mansour qurachi department pediatrics al yamama hospital riyadh saudi arabia published online6 oct 2011httpsdoiorg1041030256494784628sectionspdf toolsadd favoritesdownload citationtrack citations shareshare onfacebooktwitterlinked inredditemail aboutabstractbackground objective data stature saudi children adolescents limited objective report establish national prevalence short stature saudi children adolescentsdesign setting communitybased crosssectional study conducted 2 years 2004 2005patients methods national data set saudi reference used calculate stature age children adolescents 5 18 years age using 2007 world health organization reference prevalence moderate severe short stature defined proportion children whose standard deviation score stature age less 2 3 respectively addition 2000 center disease control cdc older 1978 national center health statistics nchswho references used comparisonresults using 2007 reference sample size saudi reference 19 372 healthy children adolescents 5 17 years age 508 boys overall prevalence moderate severe short stature boys 113 18 respectively girls 105 12 respectively prevalence moderate short stature 121 11 113 boys 109 113 105 girls 1978 2000 cdc 2007 references used respectivelyconclusions national prevalence short stature saudi children adolescents intermediate compared international level improvement socioeconomic health status children adolescents lead reduction prevalence short statureintroductionshort stature also called stunting children adolescents common reason referral specialized clinics investigation addition obvious causes dysmorphic syndromes skeletal dysplasias systemic endocrine diseases short stature may presentation treatable conditions isolated growth hormone deficiency celiac disease13 known causes excluded remains entity called isolated idiopathic short stature normal children causes short stature group thought related environmental factors chronic undernutrition genetics4 shown higher energy availability female literacy gross domestic product important factors associated lower prevalence stunting5 example study brazil showed reduction socioeconomic inequality resulted marked decrease stunting6 addition psychosocial implications78 short stature associated overweight obesity risk implications910 although prevalence undernutrition including stunting preschool children extensively reported countries11 information prevalence short stature older children adolescents scarce worldwide therefore objective study establish national prevalence short stature saudi children adolescentspatients methodsthe prevalence short stature saudi schoolage children adolescents 518 years age calculated data set national saudi reference design methodology survey used establish latter reference reported detail elsewhere12 brief multistage probability procedure used randomly select crosssectional sample stratified listing population saudi arabia available time study design therefore sample representative socioeconomic strata including weighted urbanrural representation housetohouse visits made selected houses primary care physicians nurses completed survey questionnaire clinical examination body measurements weight stature measurements performed healthy children adolescents trained physicians nurses according recommended standards13 prevalence moderate severe short stature defined proportion children whose standard deviations score z score stature age 2 3 respectively 2007 world health organization reference used calculate prevalence moderate severe short stature two commonlyused references 1977 national center health statistics nchs subsequently recommended 1978 became known 1978 nchswho reference 2000 center disease control cdc reference used comparison data found literature1415 calculations performed using appropriate software published cdc respectively1617 chisquare test used compare proportions p value 05 considered significantresultsthe national sample size saudi reference 19 372 healthy children adolescents 5 17 years age 508 boys applying 2007 reference sample prevalence figures moderate severe short stature boys 113 18 respectively table 1 105 12 respectively girls table 2 1978 nchswho reference boys significantly higher prevalence girls 121 vs 109 p011 whereas significant difference prevalence boys girls found using either 2000 cdc 11 vs 113 p518 2007 reference 113 vs 105 p086 table 3 comparison effect type reference prevalence short stature revealed different results boys girls boys prevalence significantly higher using 1978 nchswho reference using 2000 cdc reference 121 vs 11 p018 similarly significant difference overall prevalence boys neither 2007 2000 cdc references 113 vs 11 p524 1978 nchswho 2007 references 121 vs 113 p524 girls difference prevalence short stature significant pairs three references significant difference prevalence neither 2000 cdc 1978 nchswho 113 vs 109 p397 references 1978 nchswho 2007 references 109 vs 105 p397 2000 cdc 2007 references 113 vs 105 p524table 1 prevalence short stature age boys 2007 referencetable 1 prevalence short stature age boys 2007 referencetable 2 prevalence short stature age girls 2007 referencetable 2 prevalence short stature age girls 2007 referencetable 3 prevalence short stature haz 2 sd type referencetable 3 prevalence short stature haz 2 sd type referencediscussionprevalence data important surveillance physical growth children populations time although considerable attention given monitoring growth preschool children increasing interest schoolaged children adolescents fact cases short stature age group result chronic effect malnutrition increasingly reported health hazards provides support need monitoring preventionthe study sample report national representative saudi children adolescents 5 18 years age slight difference sample size used two types references due fact calculations performed time 2007 software available much later onesin analysis used primarily recent 2007 reference based 1977 nchs data reconstructed using stateoftheart statistical methods1819 provided best alignment 2006 child growth standards14 accordingly 2007 reference probably represents uptodate reference monitor growth schoolaged children adolescents therefore recommended international use20 previous reports used older references 1978 nchswho 2000 cdc references also used calculate prevalence moderate short stature comparison data reported literature difficult differences sample selection study age groups use different references calculate prevalence short stature report west bank palestine prevalence stunting school children aged 1315 years 92 73 boys girls respectively ramallah 94 42 boys girls respectively hebron21 values much lower results irrespective reference used however sample study national iotf reference used define stunting height age less third percentile roughly corresponds 2 sd22 report stunting indian adolescents aged 1116 living south india compared sample ethnic background living dubai united arab emirates uae using 1978 nchswho reference revealed prevalence stunting 388 369 boys girls respectively living india compared 89 116 south indian students living uae23 result different average prevalence stunting age group 144 148 saudi boys girls respectively finding report marked difference prevalence stunting indicator chronic malnutrition two samples ethnic origin living different demographic socioeconomic environments observation line previous reports suggesting national variability stunting explained socioeconomic demographic factors improvement socioeconomic status led marked improvement nutritional status general marked decline prevalence stunting children less 5 years age expected positive effects stature older children56 crosssectional study eight provinces china revealed prevalence stunting age group 1018 years 23 1991 decreased 19 199324 using 1978 nchswho reference prevalence stunting defined height age z score 2 sd rural region south africa reported 5 7 children adolescents 520 years age25 similar prevalence levels 57 reported turkey school children 616 years age26 whereas study rural pakistan reported prevalence 165 school children 612 years age27in report prevalence short stature increased age irrespective gender type reference used addition although boys tended higher prevalence stunting across age groups difference overall prevalence significant 1978 nchswho reference finding consistent previous report institution probably reflecting difference timing maturation girls boys resulting lower growth girls among schoolaged children adolescents28 lack significant difference boys girls two recent references 2000 cdc 2007 interesting could due secular changes tendency girls taller previous generations finally effect type reference assessment prevalence short stature boys girls although slightly significant boys seen difference prevalence found using 1978 nchswho reference found using 2000 cdc reference generally considered insignificant pattern could related different statistical methods used constructing newer references possibly combined effect secular changesin conclusion report establishes baseline prevalence short stature representative sample saudi children adolescents intermediate international level global improvement socioeconomic status children lead reduction prevalence short stature national levelarticle references1 wit jm clayton pe 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history accepted1 october 2010published online6 october 2011 acknowledgementsthis study funded king abdulaziz city science technology riyadh kingdom saudi arabia grant ar2063informationcopyright 2011 annals saudi medicinethis openaccess article distributed terms creative commons attributionnoncommercialshare alike 30 unported permits unrestricted use distribution reproduction medium provided original work properly citedpdf download