Birth in winter can reduce the risk of lung cancer: A retrospective study of the birth season of patients with lung cancer in Beijing area,China

The season of birth is an important risk factor for several diseases. We explored the relationship between birth season and lung cancer. In this population-based retrospective study, we focused on patients with lung cancer who had registered at the Beijing Institute for Cancer Research from 2003 to 2012. In total, 33,025 patients were divided into five subgroups based on their histologic classification, and these five subgroups were compared with the general population (i.e., the permanent resident population of Beijing in 2013). A binary logistic regression method with sex and age as control factors was used to evaluate the relationship between birth season and lung cancer; P < 0.01 was statistically significant. Taking winter as a reference in our analysis of the relationship between season of birth and lung cancer, we found that people who were born in other seasons had a higher probability of developing lung cancer (spring: odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.03–1.09; summer: OR = 1.07, 95% CI = 1.04–1.10; autumn: OR = 1.06, 95% CI = 1.03–1.09) (P < 0.01). Among the five subgroups, persons with squamous cell carcinoma who were born in summer were more likely to develop lung cancer than those who were born in winter (OR = 1.09, 95% CI = 1.02–1.15, P = 0.006). The other subgroups showed no correlation with season of birth (P > 0.01). This study demonstrates that for people born in winter, the risks of developing lung cancer and squamous cell carcinoma are comparatively lower than those for people born in other seasons. Differences in immune function and the maternal nutrition status during pregnancy of people born in different seasons may explain this finding.     

Effect of paternal age on the birth sex ratio in captive populations of aye‐aye (Daubentonia madagascariensis (Gmelin))

For the management of captive populations of zoo animals, it is important to elucidate factors that affect the offspring birth sex ratio. On the basis of the sex allocation theory, the Trivers–Willard and mate attractive/quality hypotheses predict that maternal and paternal conditions affect offspring birth sex ratios. We examined these predictions for the birth sex ratio of aye‐aye Daubentonia madagascariensis (Gmelin) by analyzing the pedigree information in the International Studbook. We found that the birth sex ratio of the aye‐aye was affected by the paternal age, but not maternal age and other environmental factors (birth year, season, and institution). The younger the sire, the more the offspring sex ratio was biased toward males. These results are useful for the effective population management of captive aye‐aye and illustrated the usefulness of the sex allocation theory in the sex ratio management of zoo animals.     

Birth weight correlates differently with cardiovascular risk factors in youth

Objective: Childhood obesity has become prevalent, resulting in a greater risk of hypertension, diabetes, and dyslipidemia. However, the relationship between these comorbid conditions and birth weight remains uncertain. We conducted this study to evaluate the relationship between birth weight and cardiovascular risk factors in children and adolescents. Research Methods and Procedures: In a nationwide survey conducted between 1992 and 2000, all schoolchildren 6 to 18 years old with glucosuria, proteinuria, or microscopic hematuria in repeated urine samples were included and received a physical examination and blood test. Those with gestational age <37 weeks were excluded. We enrolled 81,538 children (51,111 girls and 30,427 boys) and obtained their birth weights from the Taiwan Birth Registry. Obesity and hypertension were defined by age‐ and sex‐specific cut‐offs. Diabetes was diagnosed if the fasting glucose was >7 mM. Results: The risk of obesity was higher for those with birth weights ≥4000 grams [odds ratio (OR), 1.65] and 3543 to 3999 grams (OR, 1.28) and lower for those with birth weights 2601 to 2999 grams (OR, 0.90), using 3000 to 3542 grams as the reference group. An increased risk of diabetes was associated with both higher and lower birth weights, indicating a U‐shaped relationship (OR, <2600 grams, 1.607; 2601 to 2999 grams, 1.119; 3543 to 3999 grams, 1.112; ≥4000 grams, 1.661). In the 10‐ to 12‐year‐old age group, the risk of hypertension was higher in those with birth weights <2600 grams (OR, 1.20). Discussion: Low birth weight was associated with childhood diabetes. High birth weight was correlated with childhood obesity and diabetes. Our data indicate different relationships between birth weight and the development of obesity, hypertension, and diabetes in childhood.     

Environmental and sibling resemblance components of variance and covariance in traits of early child development

The multiple regression analyses were undertaken to elucidate the significance and relative importance of different potential determinants of several child development traits (i.e. age at which child 1. turns himself over; 2. sits up; 3. stands up; 4. walks, and 5. cuts his first tooth). Despite the fact that we used a relatively wide gamut of potential determinants (such as parental age, geographic origin, occupation, current residence, or family size) of trait variability, the results of multiple regression analysis (N = 300 families) indicate an almost complete absence of significant factors and studied variables of development. Sibling resemblance component of variance and covariance for five mentioned traits of development and some morphological characters (weight, length and head circumference at day of birth and at 16 months) were studied in 66 families. The transmissibility ("heritability") values for the development traits were small, ranging from 0 ("Turn") to 0.42 ("Walked"). The Findings suggest that there are significant inverse relationship between some of the developmental traits and inborn morphological characters.     

Group Composition Affects Seasonal Birth Timing in Captive Japanese Macaques

We analyzed birth dates recorded during an 18-year period in a group of Japanese macaques housed in the Rome zoo to assess the influence of environmental, physiological, and social factors on birth seasonality. Birth timing differed significantly among years. Birth timing was affected by reproductive condition of females—ones that had given birth in the previous year delivered significantly later than those that had not—but not by their age or dominance rank. We conducted further analyses separately on females that had or had not given birth in the previous year. In both subgroups of females mean birth date was not influenced either by environmental temperature and rainfall during the previous mating season or by group size. On the contrary, among females that had not given birth in the previous year, socionomic sex ratio—ratio of sexually mature males to sexually mature females—is positively correlated with both mean birth date and date of the first birth, but not with date of the last birth. Contrarily, among females that had given birth in the previous year, there is no significant relationship between these variables. We hypothesize that the effects of socionomic sex ratio on birth timing might depend on competition among males for access to fertile females. When the number of males per female was higher, mutual disruption of consort pairs may have led to a delay in the onset of mating.     

Biomechanical association of dental and temporomandibular pathology in a medieval Nubian population

An analysis of the relationship between oral pathology and degenerative change at the temporomandibular joint (TMJ) was undertaken on an archaeological sample of 122 adult crania from the Medieval site of Kulubnarti in Sudanese Nubia. The crania were sorted into 2 groups: those demonstrating clearly visible bony changes at the joint (TMJ+) and those without visible change (TMJ-). These groups were compared according to 1) age; 2) sex; 3) active dental pathologies (abscesses, caries, partial socket resorption); 4) tooth loss with complete socket resorption; and 5) dental attrition. No statistically significant association was evident between degenerative change at the TMJ and age, active dental pathologies, or dental attrition; however, sex differences and posterior tooth loss with complete socket resorption revealed a significant correspondence to degenerative TMJ changes. Both of these factors agree with the clinical literature and with biomechanical models (most notably that of Hylander) based upon modern populations. Furthermore, the results support the contention that paleopathological conditions can be analyzed from a clinical and functional biomechanical perspective.     

FLUCTUATING ASYMMETRY IN CENTRAL AND MARGINAL POPULATIONS OF LYCHNIS VISCARIA IN RELATION TO GENETIC AND ENVIRONMENTAL FACTORS

Developmental instability in the form of increased fluctuating asymmetry can be caused by either genetic or environmental stress. Because extinctions can be attributed broadly to these factors, fluctuating asymmetry may provide a sensitive tool for detecting such stresses. We studied the level of fluctuating asymmetry of flowers of a perennial outcrossing plant species, Lychnis viscaria, both in natural and common-garden populations. The degree of flower asymmetry was higher in small, isolated, and marginal populations of the species range. These marginal populations also were the most homozygous. In the core area of the species' range, flowers were more symmetrical The level of asymmetry was correlated with both population size and heterozygosity. However, a partial correlation analysis revealed that when the impact of population size was controlled for, there was a negative relationship between fluctuating asymmetry and heterozygosity, whereas when controlling for heterozygosity, no relationship between population size and fluctuating asymmetry was found. This indicates that genetic consequences of small population size probably underlie the relationship between the level of asymmetry and population size. Results from a transplantation experiment showed that individuals subjected to a higher environmental stress had an increased level of asymmetry compared to control plants. In the common-garden conditions the level of fluctuating asymmetry did not differ between the central and marginal populations. This suggests that presumably both genetic and environmental factors affected to the higher level of asymmetry among marginal populations compared to central ones. In all we conclude that even though fluctuating asymmetry seems to be a sensitive tool for detecting stresses, results from studies focusing on only one factor should be interpreted with caution.     

Sex-specific fitness returns are too weak to select for non-random patterns of sex allocation in a viviparous snake

When environmental conditions exert sex-specific selection on offspring, mothers should benefit from biasing their sex allocation towards the sex with the highest fitness in a given environment. Yet, studies show mixed support for such adaptive strategies in vertebrates, which may be due to mechanistic constraints and/or weak selection on facultative sex allocation. In an attempt to disentangle these alternatives, we quantified sex-specific fitness returns and sex allocation (sex ratio and sex-specific mass at birth) according to maternal factors (body size, age, birth date, and litter size), habitat, and year in a viviparous snake with genotypic sex determination. We used data on 106 litters from 19 years of field survey in two nearby habitats occupied by the meadow viper Vipera ursinii ursinii in south-eastern France. Maternal reproductive investment and habitat quality had no differential effects on the growth and survival of sons and daughters. Sex ratio at birth was balanced despite a slight female-biased mortality before birth. No sexual mass dimorphism between offspring was evident. Sex allocation was almost random apart for a trend towards more male-biased litters as females grew older, which could be explained by an inbreeding avoidance strategy. Thus, a weak selection for facultative sex allocation seems sufficient to explain the almost equal sex allocation in the meadow viper.     

Using Penalized Splines to Model Age‐ and Season‐of‐Birth‐Dependent Effects of Childhood Mortality Risk Factors in Rural Burkina Faso

Several previous studies have identified risk factors for childhood mortality in high risk areas, such as Sub‐Saharan Africa. Among these are lifestyle factors related for example to nutrition or sanitation. Other factors are related to social class, ethnicity and poverty in general. Few studies have investigated a dependence of these factors by age and season of birth which is the focus in this study. We perform a survival analysis of 9121 children born between 1998 and 2001 in a rural area of western Burkina Faso. The whole population is under demographic surveillance since 1993. All cause mortality is used as the endpoint and follow‐up information until the age of five years is available. Recently developed spline regression methods are used for the analysis. Ethnic group, religion, age of mother, twin status, sex, and distance to next health center are used as covariates all of which having a clear effect on survival in standard Cox regression analysis. With penalized spline regression, a more detailed risk pattern is observed. Ethnicity is more related to death at early age, as well as age of mother. The effect of the risk factors considered also appear to be related with season of birth (© 2009 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Blood Pressure in Adolescence and Early Adulthood Related to Obesity and Birth Size

Objective: Obesity is an established risk factor for higher systolic (SBP) and diastolic (DBP) blood pressure in adolescence and early adulthood, but birth size may also have a role. We analyzed the effects of adolescent and adult obesity and birth size on BP in the young adult. Research Methods and Procedures: In a prospective longitudinal study, anthropometric measurements were obtained at birth on 67 boys and 67 girls bom in Boston. Their body mass indices (BMI) and BP were recorded 17 years and 30 years later. Results: For women, adolescent and early adult obesity appeared to be the stronger determinants of higher BP, although smaller head and chest circumferences at birth may also be related. We found some evidence of birth (ponderal index [PI] and head circumference) anthropometric influences on age 17 BP levels in boys. By age 30, body mass variables were the dominant predictors of male BP levels. Female BMI at age 17 was positively correlated with birth adiposity (PI), but BMI at 30 was related only to age 17 BMI. Similarly, male BMI at 17 years was higher for those who weighed more at birth, but BMI at 30 years was again related only to age 17 BMI. Discussion: We conclude that adult weight and weight gain are the major determinants of adult BP.     

Changing determinants of infant and child mortality: on the basis of the Korean experience, 1955-73

Data from the 1974 Korean National Fertility Survey were analyzed to learn more about the main determinants of infant and child mortality in the course of mortality decline and how they change. In the Korean survey, about 5000 eligible women were selected for the individual survey and the sample design aimed at a self-weighting nationally representative and probability sample. Preliminary analysis showed clear mortality differentials between different socioeconomic levels and between demographic subgroups in infant and child mortality during the period 1955-73 in Korea. To examine the net effect of each variable on mortality, the logit-linear model was used. A table shows the probability level of 4 variables -- maternal age, birth order, mother's education, and number of rooms used by household -- in Korea, when the effects of others were controlled. In the urban areas, only the socioeconomic factors were the main determinants of infant mortality on all the birth cohorts. Mother's education and number of rooms used strongly affected infant mortality in the 1955-59 and 1960-64 birth cohorts, but the effects became weaker in the 1965-69 and 1970-73 birth cohorts, and their statistical significance was reduced. In the rural areas, the effects of 3 variables -- the exception being number of rooms used -- on infant mortality were statistically significant. It is concluded that the main determinants of infant mortality in urban areas were socioeconomic factors. The main determinants of infant mortality in the rural areas were demographic in the earlier birth cohorts, but in the recent birth cohorts mother's education, a socioeconomic factor, became the main determinant while the effects of demographic variables became weaker and finally disappeared. The change in the determinants of child mortality appears to be the reverse of that for infant mortality. Prior to the introduction of the national development program, in the rural areas mother's education was the main determinant of child mortality (rural 1955-59 cohort), but with the socioeconomic development the determinants changed to give dominance to demographic factors (urban 1955-59) cohort and, in the recent period, even the effects of demographic factors on child mortality became weaker (urban 1960-69 cohort). When the differences in living status by maternal age were weaker and the competition among siblings less because of small family size, only the socioeconomic variables remained as main determinants affecting child mortality.     

The association between birth weight and visceral fat in middle-age adults

Objective: Low birth weight, a proxy for fetal underdevelopment, is associated with increased risk of developing type 2 diabetes during adulthood. Low birth weight is also associated with central obesity, but little is known about the association between birth weight and visceral adiposity. The purpose of this study is to test the hypothesis that lower birth weight is associated with increased amounts of visceral fat in middle‐age adults. Research Methods and Procedures: This is an observational study of 91 adults (58 men and 33 women) 40 ± 6 years of age (mean ± standard deviation). Ethnicity was either Japanese American (79%) or non‐Hispanic white (21%). Birth weight was obtained from State Departments of Health. Measurements included smoking status, BMI, and visceral (intra‐abdominal) fat measured by computed tomography. Results: Visceral fat was not associated with birth weight after adjustment for age, sex, ethnicity, BMI, or smoking status (p = 0.76). There was no evidence that the association between birth weight and visceral fat varied by age, sex, or ethnicity. Discussion: We found no evidence that low birth weight is associated with increased visceral fat in middle‐age adults     

Social rank and sex ratio of captive long-tailed macaque females (Macaca fascicularis)

Variation in birth sex ratios in primates can be accounted for by two hypotheses: the local resource competition hypothesis [Silk: American Naturalist 121:56–66, 1983] and the hypothesis of Trivers & Willard [Science 179:90–92, 1973] concerning the maternal effect on the quality of a male. We examined the effects of female dominance rank on aspects of reproduction in three well-established captive groups of long-tailed macaques (Macaca fascicularis). High-ranking females produced a higher proportion of sons than low-ranking females, and factors other than rank did not have significant effects on birth sex ratios. Interbirth intervals following daughters were longer than those following sons, but they were independent of the mother's rank. The sons of high-ranking mothers had better survival prospects than sons of low-ranking mothers in some of the groups; no such difference was found for daughters. Overall, there was no sex difference in survival up to 5 years of age. These results support the Trivers-Willard hypothesis rather than the local resource competition hypothesis. An analysis of interbirth intervals suggested that the deviation in birth sex ratio is already established at conception.     

Determinants of the sex ratio at birth: review of recent literature

The fact that more boys are born than girls (104-107 boys for every 100 girls) has been known since 1662. Factors determining the sex ratio at birth rate are of 2 kinds: factors determining the primary sex ratio, i.e., sex ratio at conception, and factors determining the survival of the embryo in utero. Y-bearing and X-bearing sperm may have different motility or different survival time. The age of the ovum at fertilization and the chemical balance of the female genital tract have an effect on sex ratio at conception. High levels of circulating gonadotropins may imply a lower sex ratio at birth as well as a higher rate of dizygotic twinning. Male conception also appears to be higher early and late in the menstrual cycle. The fact that women exposed to higher coital rates conceive earlier in the menstrual cycle may account for the greater number of boys born during wars. Prenatal male mortality is reportedly highest between gestational months 3-5, lower between months 6-8, and higher again st term. Also, immunological interaction between mother and embryo may account for some sex selective spontaneous abortions. 3 sociodemographic determinants of sex ratio at birth are thought to be maternal age, paternal age, and birth order. Higher prenatal male mortality may be correlated with socioeconomic conditions, since higher socioeconomic status lowers prenatal mortality in general. The effects of parental age, birth order, and parity are less clear. Race is also a factor, since the sex ratio at birth for blacks is lower (102-104) than for whites (106). 14 univariate and 19 multivariate studies of effects of maternal age, paternal age, parity, birth order, race, and socioeconomic status on sex ratio at birth, with sample sizes in the millions from various countries have been analyzed. More boys are born to younger parents, and lower order births have a higher proportion of males than do higher order births. In the multivariate analyses, when the effects of paternal and and birth order are controlled for, the effect of maternal age weakens, and the effect of paternal age appears to be stronger. The effect of birth order remains but is very small, and the effect of race persists independent of any effect of other variables. Maternal age, parity, and birth order are positively correlated with proportion of male stillbirths. The results of the multivariate analyses show all of the effects to be very small, but that maternal age has no effect on sex ratio at birth; paternal age and birth order have a negative effect, and the racial effect persists independent of any other effect. The racial effect is clearly biologically determined at conception because blacks have higher levels of circulating gonadotropin and therefore a higher probability of conceiving girls. Parents in higher socioeconomic classes are more likely to have sons, but the effect is largely due to the excess male mortality during most of the gestational period.     

Sex ratio in silver foxes: effects of domestication and the star gene

The course of changes in secondary sex ratio (proportion of males at birth) in silver foxes bred at the fur farm of this Institute was analyzed. Data collected over several years of breeding of a domesticated (experimental) population selected for amenability to domestication and of a commercial (control) were compared. A tendency to increase in secondary sex ratio was demonstrated in both populations. However, the proportion of males at birth was higher in domestic foxes. This proportion, calculated from the combined data for 1978–1993, was 0.538±0.005 and 0.511±0.007 in the selected and commercial populations, respectively. The minimal departure of the observed sex ratio from 0.5 was demonstrated for litters with five pups, which is close to the average litter size in fox populations. The proportion of males increases with both increasing and decreasing litter size. An analysis of secondary sex ratio with respect to maternal age revealed a minimal departure of sex ratio from the expected in offspring from foxes of optimal reproductive age (2–4 years). An effect of the autosomal semidominant coat color mutation star on male excess at birth was also found: secondary sex ratio was higher (0.583±0.015) in offspring of mothers heterozygous for the star mutation than from standard types of the domesticated population. The increase in secondary sex ratio in the analyzed fox populations is viewed as a correlated response to selection for domestication. The hormonal mechanisms mediating the effects of both this selection and the star mutation on sex ratio at birth are discussed.     

Demography and social organization of free-ranging Lemur catta in the Beza Mahafaly Reserve,Madagascar

In 1987, a long-term study of the demography of Lemur catta was begun in southern Madagascar. Eighty-five ringtailed lemurs were captured, marked, and released. Adult age classes were estimated using patterns of dental attrition. Including young, 155 individuals from nine groups were identified and monitored over 18 months. The study population of the reserve remained stable, with a growth rate of 0.98. Group sizes ranged from nine to 22 individuals (mean 14). Home ranges were larger (32 ha) and population densities lower (135/km²) than those for previously studied populations, and there was a relationship between habitat quality (e.g., no. of large trees) and these factors. At the beginning of the study, there were more adult males than females, but the sex ratio reached 1.00 by the last census. Females first gave birth at 3 years of age, and 80% or more of the females gave birth in 2 consecutive years. Fifty-two percent of the infants died in the first year and, given preliminary findings, only 40% of those born reach adulthood. Age-specific fertility patterns were similar to those reported for anthropoid primates. Forty-seven percent of the adult males migrated or were missing within a year. This included 78% of the 3–4 year olds and 38% of older age classes. No females were observed to migrate. One group split during the study. Demographic patterns are discussed and related to patterns in other populations of ringtailed lemurs as well as in anthropoids.     

Social determinants associated with Zika virus infection in pregnant women

This study aims to describe the sociodemographic determinants associated with exposure to Zika Virus (ZIKV) in pregnant women during the 2015–2016 epidemic in Salvador, Brazil.MethodsWe recruited women who gave birth between October 2015 and January 2016 to a cross-sectional study at a referral maternity hospital in Salvador, Brazil. We collected information on their demographic, socioeconomic, and clinical characteristics, and evaluated their ZIKV exposure using a plaque reduction neutralization test. Logistic regression was then used to assess the relationship between these social determinants and ZIKV exposure status.ResultsWe included 469 pregnant women, of whom 61% had a positive ZIKV result. Multivariate analysis found that lower education (adjusted Prevalence Rate [aPR] 1.21; 95%CI 1.04–1.35) and food insecurity (aPR 1.17; 95%CI 1.01–1.30) were positively associated with ZIKV exposure. Additionally, age was negatively associated with the infection risk (aPR 0.99; 95%CI 0.97–0.998).ConclusionEve after controlling for age, differences in key social determinants, as education and food security, were associated with the risk of ZIKV infection among pregnant women in Brazil. Our findings elucidate risk factors that can be targeted by future interventions to reduce the impact of ZIKV infection in this vulnerable population.     

Sexual dimorphism of the human mandible and its association with dental development

The present study investigates whether the human mandible is sexually dimorphic during early postnatal development and whether early dimorphic features persist during subsequent ontogeny. We also examine whether mandibular dimorphism is linked to dimorphism of dental development. Dense CT-derived mandibular meshes of 84 females and 75 males, ranging from birth to adulthood, were analyzed using geometric morphometric methods. On the basis of the specimen's chronological ages and mineralization stages of the deciduous and permanent teeth, we compute dental age as proxy for dental development by the additive conjoint measurement method. By birth, males have, on average, more advanced age-specific shapes than females. However, sex differences decrease quickly as females catch up via a different association between shape and size. This leads to an almost complete reduction of sexual dimorphism between the ages of 4 and 14. From puberty to adulthood, males are characterized by allometric shape changes while the shape of the female mandible continues to change even after size has ceased to increase. Dimorphism of dental maturation becomes visible only at puberty. Sexual dimorphism, concentrated at the ramus and the mental region during the earliest ontogenetic stages and again at adulthood, is not associated with the development of the teeth. At puberty there is a simultaneous peak in size increase, shape development, and dental maturation likely controlled by the surge of sex hormones with a dimorphic onset age. We argue that the infant and adult dimorphism of the mental region may be associated with the development of supralaryngeal structures.     

Dental sexual dimorphism and morphology in african colobus monkeys as related to diet

We considered the relationship between dental sexual dimorphism and diet in 542 specimens of olive, red, and black-and-white colobus. Using univariate statistical techniques, we examined 41 measurements of the maxillary and mandibular dentitions. The results reveal two trends of dental sexual dimorphism in black-and-white colobus wherein (i) maleColobus guereza andC. angolensis are generally larger than females throughout the dentition and (ii)C. satanas and, to a lesser degree,C. polykomos exhibit reduced sexual differences in the canine base and females are slightly larger than males in noncanine dimensions. Females of the red colobus,Procolobus (Piliocolobus) badius, are slightly larger than males in most noncanine measurements but canine sex differences are more pronounced than those of black-and-white colobus.Procolobus (Procolobus) verus, the olive colobus, is characterized by some of the largest canine sex differences, yet the sexes do not differ much in noncanine mean values. When patterns of sexual dimorphism are considered in terms of specific ecology and behavior, it is possible to relate sex differences, in part, to known dietary differences. For example, overall dental morphology and the trend of sexual differences inC. satanas andC. polykomos seem to be associated with the consumption of a diet rich in seeds. The pattern of dental sexual dimorphism inC. badius may also be influenced by dietary factors in that their patrilineal social organization could restrict female access to certain foods thereby affecting rates of attrition and creating selection pressure for larger teeth. Relatively less is known of the ecology and social organization ofP. verus but their dental sexual dimorphism is possibly less related to dietary factors than is the case for red or black-and-white colobus.     

Understanding Child Stunting in India: A Comprehensive Analysis of Socio-Economic,Nutritional and Environmental Determinants Using Additive Quantile Regression

Background

Most attempts to address undernutrition, responsible for one third of global child deaths, have fallen behind expectations. This suggests that the assumptions underlying current modelling and intervention practices should be revisited.

Objective

We undertook a comprehensive analysis of the determinants of child stunting in India, and explored whether the established focus on linear effects of single risks is appropriate.

Design

Using cross-sectional data for children aged 0–24 months from the Indian National Family Health Survey for 2005/2006, we populated an evidence-based diagram of immediate, intermediate and underlying determinants of stunting. We modelled linear, non-linear, spatial and age-varying effects of these determinants using additive quantile regression for four quantiles of the Z-score of standardized height-for-age and logistic regression for stunting and severe stunting.

Results

At least one variable within each of eleven groups of determinants was significantly associated with height-for-age in the 35% Z-score quantile regression. The non-modifiable risk factors child age and sex, and the protective factors household wealth, maternal education and BMI showed the largest effects. Being a twin or multiple birth was associated with dramatically decreased height-for-age. Maternal age, maternal BMI, birth order and number of antenatal visits influenced child stunting in non-linear ways. Findings across the four quantile and two logistic regression models were largely comparable.

Conclusions

Our analysis confirms the multifactorial nature of child stunting. It emphasizes the need to pursue a systems-based approach and to consider non-linear effects, and suggests that differential effects across the height-for-age distribution do not play a major role.