Academic journal article Journal of Health Population and Nutrition

Major Dietary Patterns in Relation to Stunting among Children in Tehran, Iran

Academic journal article Journal of Health Population and Nutrition

Major Dietary Patterns in Relation to Stunting among Children in Tehran, Iran

Article excerpt


Stunting, defined as "the gaining of insufficient height relative to age" (1) during childhood is a major public-health problem in underdeveloped and developing countries (1-4). The 2000 report of the World Health Organization (WHO) stated that 215 million children were stunted. Findings from a national survey in Iran in 2005 indicated that 4.7% of Iranian children were affected (5). Stunting in children is associated with current, and possibly later, delayed mental and motor development (67). Limited work-capacity due to reduced muscle mass has also been reported among stunted people (6). Earlier studies have also found increased obstetric risks among stunted women (8).

Linear growth retardation, which is the manifestation of chronic malnutrition, can be developed from inadequate intake of food, inappropriate quality of diet, or a combination of both (6-10). Numerous studies that have been conducted on growth-limiting nutrients have indicated that primary deficiency of zinc, vitamin A, and iron, along with insufficient intake of protein and energy, might result in stunting (5,11-14). However, it must be kept in mind that interactions between nutrients might confound the association of a specific nutrient with stunting. To overcome these problems, nutritional epidemiologists have suggested the use of a dietary pattern approach as a new direction in nutritional epidemiology to find diet-disease relationships (14). Using a multivariate approach could control potential dietary confounders and food and nutrient interactions (15-17).

Generally, several studies have assessed dietary patterns in relation to numerous outcomes. Most of these studies have been performed among adults in western societies; limited information is available about major dietary patterns of children worldwide, particularly in region of the Middle East not studied well. Furthermore, although the association of several nutrients with stunting has received great attention, we are unaware of any studies linking major dietary patterns to stunting, particularly among children (12-14,18). This study was, therefore, conducted to determine the relationship between major dietary patterns and stunting in the first grade pupils of Tehran, Iran.



This case-control study has been done in the framework of a cross-sectional survey that was performed among 3,147 first grade pupils aged 7 years, who were selected using a multistage cluster random-sampling method from 42 elementary schools in 5 districts of Tehran (northern, southern, eastern, western, and central part of Tehran). Children's weight was measured while the subjects were minimally clothed without shoes, using digital scales and recorded to the nearest 100 g. Height was measured in a standing position, without shoes, using tapemeter while shoulders were in a normal state. Body mass index was calculated as weight in kilogramme divided by height in metres squared. To avoid subjective error, all measurements were taken by the same person. Stunting was defined as height-for-age of less than the 5th percentile of the Center for Disease Control and Prevention 2000 (CDC2000) cutoff points. Qualified children (N=117), whose parents agreed to participate in the study, were specified as a case group (n=86). After matching for age, sex, and area of residence, we selected 3 apparently healthy non-stunted children [(height-for-age equal to and more than the 5th percentile of CDC2000 cutoff points for each stunted kid as their controls (n=308)]. Therefore, in the current study, we examined 394 students in total.

The Ethics Committee of the National Nutrition and Food Technology Research Institute approved this study, and informed written consent was obtained from all participants and their parents.

Assessment of dietary intake

Dietary intakes of the study participants were assessed by means of two quantitative non-consecutive 24-hour dietary recalls (one for a weekday and the other for a weekend). …

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