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.

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