Background/Aims: Increasing agreement exists about the use of length-for-age as the indicator of choice in monitoring the long-term impact of chronic nutritional deficiency. Yet, already shortly after World War I, a causal link between nutrition and growth was questioned. Also, modern meta-analyses of controlled nutrition intervention studies show that the net effect of nutrition on body height is small. Broad evidence obtained from historic observations on human starvation made since the 19th century questions an obligatory association between nutrition and growth. Many additional explanations for the apparent shortness of people from developing countries have been published since, focusing on genetic factors, environment, economy, epigenetics, and, recently, psychosocial factors, such as strategic growth adjustments suggesting stature to be a social signal. Conclusion: The marked variability in average population height of up to 20 cm within a few generations complicates the use of normative growth charts, even though they have been widely propagated. We support the concept of local growth references, for example using the “Synthetic Growth References” methodology. These references combine local growth information obtained from a given population of interest and common features of human population growth, with LMS values for height, weight, and BMI from birth to maturity.

Lartey A: What would it take to prevent stunted growth in children in sub-Saharan Africa? Proc Nutr Soc 2015;74: 449–453.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS; Maternal and Child Undernutrition Study Group: Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008;371: 340–357.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J; Maternal and Child Undernutrition Study Group: Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008;371: 243–260.
Crookston BT, Schott W, Cueto S, Dearden KA, Engle P, Georgiadis A, Lundeen EA, Penny ME, Stein AD, Behrman JR: Postinfancy growth, schooling, and cognitive achievement: young lives. Am J Clin Nutr 2013;98: 1555–1563.
Mendez MA, Adair LS: Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr 1999;129: 1555–1562.
Perez-Escamilla R: Post-1000 days growth trajectories and child cognitive development in low- and middle-income countries. Am J Clin Nutr 2013;98: 1375–1376.
Grantham-McGregor S, Cheung YB, Cueto
S, Glewwe P, Richter L, Strupp B; Interna-tional Child Development Steering Group: Developmental potential in the first 5 years for children in developing countries. Lancet 2007;369: 60–70.
Stevens GA, Finucane MM, Paciorek CJ, Flaxman SR, White RA, Donner AJ, Ezzati M: Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Lancet 2012;380: 824–834.
Fink G, Peet E, Danaei G, Andrews K, McCoy DC, Sudfeld CR, Smith Fawzi MC, Ezzati M, Fawzi WW: Schooling and wage income losses due to early-childhood growth faltering in developing countries: national, regional, and global estimates. Am J Clin Nutr 2016;104: 104–112.
Boyd E: Origins of the Study of Human Growth. Eugene, University of Oregon Health Science Foundation, 1980.
Koch EW: Über die Veränderung menschlichen Wachstums im ersten Drittel des 20. Jahrhunderts. Leipzig, Barth, 1935.
Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL: The Biology of Human Starvation. Minneapolis, University of Minnesota Press, 1950.
Hermanussen M, Burmeister J, Burkhardt V: Stature and stature distribution in recent West German and historic samples of Italian and Dutch conscripts. Am J Hum Biol 1995;7: 507–515.
Boersma B, Wit JM: Catch-up growth. Endocr Rev 1997;18: 646–661.
Griffin IJ: Catch-up growth: basic mechanisms. Nestle Nutr Inst Workshop Ser 2015;81: 87–97.
Chen LL, Hu X, Zheng J, Kong W, Zhang HH, Yang WH, Zhu SP, Zeng TS, Zhang JY, Deng XL, Hu D: Lipid overaccumulation and drastic insulin resistance in adult catch-up growth rats induced by nutrition promotion after undernutrition. Metabolism 2011;60: 569–578.
Alexeev EE, Lonnerdal B, Griffin IJ: Effects of postnatal growth restriction and subsequent catch-up growth on neurodevelopment and glucose homeostasis in rats. BMC Physiol 2015;15: 3.
Gat-Yablonski G, Phillip M: Nutritionally-induced catch-up growth. Nutrients 2015;7: 517–551.
Haddad L, Achadi E, Bendech MA, Ahuja A, Bhatia K, Bhutta Z, Blossner M, Borghi E, Colecraft E, de Onis M, Eriksen K, Fanzo J, Flores-Ayala R, Fracassi P, Kimani-Murage E, Nago Koukoubou E, Krasevec J, Newby H, Nugent R, Oenema S, Martin-Prevel Y, Randel J, Requejo J, Shyam T, Udomkesmalee E, Reddy KS: The Global Nutrition Report 2014: actions and accountability to accelerate the world’s progress on nutrition. J Nutr 2015;145: 663–671.
Uauy R, Albala C, Kain J: Obesity trends in Latin America: transiting from under- to overweight. J Nutr 2001;131: 893S–899S.
Sguassero Y, de Onis M, Carroli G: Community-based supplementary feeding for promoting the growth of young children in developing countries. Cochrane Database Syst Rev 2005:CD005039.
Sguassero Y, de Onis M, Bonotti AM, Carroli G: Community-based supplementary feeding for promoting the growth of children under five years of age in low and middle income countries. Cochrane Database Syst Rev 2012:CD005039.
Kristjansson E, Francis DK, Liberato S, Benkhalti Jandu M, Welch V, Batal M, Greenhalgh T, Rader T, Noonan E, Shea B, Janzen L, Wells GA, Petticrew M: Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years. Cochrane Database Syst Rev 2015:
Mumm R, Ipsen MJ, Hermanussen M: The association of weight, weight variability and socioeconomic situation among children. Eur J Clin Nutr 2016;70: 650–652.
Radcliffe B, Payne JE, Porteous H, Johnston SG: “Failure to thrive” or failure to use the right growth chart? Med J Aust 2007;186: 660–661.
Garza C, de Onis M: Rationale for developing a new international growth reference. Food Nutr Bull 2004;25:S5–S14.
WHO Multicentre Growth Reference Study Group: WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006;450: 76–85.
de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J: Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85: 660–667.
de Onis M, Onyango A, Borghi E, Siyam A, Blossner M, Lutter C: Worldwide implementation of the WHO Child Growth Standards. Public Health Nutr 2012;15: 1603–1610.
Prendergast AJ, Humphrey JH: The stunting syndrome in developing countries. Paediatr Int Child Health 2014;34: 250–265.
UNICEF, WHO, World Bank: Levels and Trends in Child Malnutrition. Joint Child Malnutrition Estimates. New York, United Nations International Children’s Fund; Geneva, WHO; Washington, World Bank, 2012. Available from:
Martorell R, Zongrone A: Intergenerational influences on child growth and undernu-trition. Paediatr Perinat Epidemiol 2012;
26(suppl 1):302–314.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de OM, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R: Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382: 427–451.
Khadilkar V, Khadilkar A: Growth charts: a diagnostic tool. Indian J Endocrinol Metab 2011;15(suppl 3):S166–S171.
Christesen HT, Pedersen BT, Pournara E, Petit IO, Juliusson PB: Short stature: comparison of WHO and national growth standards/references for height. PLoS One 2016;
Saari A, Sankilampi U, Dunkel L: Multiethnic WHO growth charts may not be optimal in the screening of disorders affecting height: Turner syndrome as a model. JAMA Pediatr 2013;167: 194–195.
NCD Risk Factor Collaboration (NCD-RisC): A century of trends in adult human height. Elife 2016;5:e13410.
Formicola V, Giannecchini M: Evolutionary trends of stature in upper Paleolithic and Mesolithic Europe. J Hum Evol 1999;36: 319–333.
Schonbeck Y, Talma H, Van Dommelen P, Bakker B, Buitendijk SE, Hirasing RA, Van Buuren S: The world’s tallest nation has stopped growing taller: the height of Dutch children from 1955 to 2009. Pediatr Res 2013;73: 371–377.
Tyrrell J, Jones SE, Beaumont R, Astley CM, Lovell R, Yaghootkar H, Tuke M, Ruth KS, Freathy RM, Hirschhorn JN, Wood AR, Murray A, Weedon MN, Frayling TM: Height, body mass index, and socioeconomic status: mendelian randomisation study in UK Biobank. BMJ 2016;352:i582.
Wood AR, Esko T, Yang J, et al: Defining the role of common variation in the genomic and biological architecture of adult human height. Nat Genet 2014;46: 1173–1186.
Yang J, Bakshi A, Zhu Z, Hemani G, Vinkhuyzen AA, Lee SH, Robinson MR, Perry JR, Nolte IM, van Vliet-Ostaptchouk JV, Snieder H; LifeLines Cohort Study; Esko T, Milani L, Magi R, Metspalu A, Hamsten A, Magnusson PK, Pedersen NL, Ingelsson E, Soranzo N, Keller MC, Wray NR, Goddard ME, Visscher PM: Genetic variance estimation with imputed variants finds negligible missing heritability for human height and body mass index. Nat Genet 2015;47: 1114–1120.
Ngure FM, Reid BM, Humphrey JH, Mbuya MN, Pelto G, Stoltzfus RJ: Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links. Ann NY Acad Sci 2014;1308: 118–128.
Deaton A: Height, health, and development. Proc Natl Acad Sci USA 2007;104: 13232–13237.
Nawathe AR, Christian M, Kim SH, Johnson M, Savvidou MD, Terzidou V: Insulin-like growth factor axis in pregnancies affected by fetal growth disorders. Clin Epigenetics 2016;8: 11.
Fu Q, McKnight RA, Callaway CW, Yu X, Lane RH, Majnik AV: Intrauterine growth restriction disrupts developmental epigenetics around distal growth hormone response elements on the rat hepatic IGF-1 gene. FASEB J 2015;29: 1176–1184.
McCullough LE, Mendez MA, Miller EE, Murtha AP, Murphy SK, Hoyo C: Associations between prenatal physical activity, birth weight, and DNA methylation at genomically imprinted domains in a multiethnic newborn cohort. Epigenetics 2015;10: 597–606.
Assmann C, Hermanussen M: Modeling determinants of growth: evidence for a community-based target in height? Pediatr Res 2013;74: 88–95.
Huchard E, English S, Bell MB, Thavarajah N, Clutton-Brock T: Competitive growth in a cooperative mammal. Nature. 2016;533: 532–534.
Hermanussen M, Scheffler C: Stature signals status: the association of stature, status and perceived dominance – a thought experiment. Anthropol Anz 2016;73: 265–274.
Milani S, Buckler JM, Kelnar CJ, Benso L, Gilli G, Nicoletti I, Faglia G, Radetti G, Bona G, Schonbeck Y, van BS, Hermanussen M, Grugni G, Marazzi N, Juliusson PB, Roelants M, Hoppenbrouwers K, Hauspie R, Bjerknes R, Lejarraga H, Sartorio A: The use of local reference growth charts for clinical use or a universal standard: a balanced appraisal. J Endocrinol Invest 2012;35: 224–226.
Oyhenart EE, Lomaglio DB, Dahinten SL, Bejarano IF, Herraez A, Cesani MF, Torres MF, Luis MA, Quintero FA, Alfaro EL, Orden AB, Bergel Sanchis ML, de Espinosa MG, Garraza M, Luna ME, Forte LM, Mesa MS, Moreno Romero S, Lopez-Ejeda N, Dipierri JE, Marrodan MD: Weight and height percentiles calculated by the LMS method in Argentinean schoolchildren. A comparative references study. Ann Hum Biol 2015;42: 439–446.
Hermanussen M, Stec K, Assmann C, Meigen C, Van Buuren S: Synthetic growth reference charts. Am J Hum Biol 2016;28: 98–111.
Hermanussen M, Assmann C, Tutkuviene J: Statistical agreement and cost-benefit: comparison of methods for constructing growth reference charts. Ann Hum Biol 2010;37: 57–69.
Pascanu I, Pop R, Barbu CG, Dumitrscu CP, Gherlan I, Marginean O, Preda C, Pocopiuc C, Vulpoi C, Hermanussen M: Development of synthetic growth charts for Romanian population. Acta Endo (Buc) 2016; 12: 309–318.
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