Predictors of short stature at age 6-7 years in Israeli children

Naama Fisch-Shvalb; Michal Yackobovitch-Gavan; Naomi Fliss-Isakov; Magnazi Moran Blaychfeld; Moshe Phillip; Ronit Endevelt; Yair Morali; Nati Brooks

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ESPE Abstracts (2024) 98 FC5.4

ESPE2024 Free Communications Growth and Syndromes (6 abstracts)

Predictors of short stature at age 6-7 years in Israeli children

Naama Fisch-Shvalb ^1,2 , Michal Yackobovitch-Gavan ^1,3 , Naomi Fliss-Isakov ^4,5 , Moran Blaychfeld Magnazi ^4,6 , Moshe Phillip ^1,2 , Ronit Endevelt ^4,7 , Yair Morali ⁴ & Nati Brooks ⁴

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¹Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petach Tikva, Israel. ²Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ³Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ⁴Ministry of Health, Jerusalem, Israel. ⁵Department of Health, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel, Tel Aviv, Israel. ⁶Hebrew University of Jerusalem–Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. ⁷Faculty of Welfare and Health, School of Public Health University of Haifa, Haifa, Israel

Background and aims: Disparities in children's height often reflect socio-economic inequalities. Our aims were: (A) to describe anthropometric and socio-demographic data of children with short stature (CDC based height-z score<-2SDS) at age 6-7 years, compared to peers with height-z score≥-2SDS. (B) To assess risk factors for short stature at age 6-7 years based on growth and socio-demographic data at age 0-2 years.

Methods: This is a retrospective case-control study. Anonymized anthropometrics measured as part of the Israeli Ministry of Health Growth Survey during the first grade between the years 2015-2019 were collected. Participants were divided by sectors (Secular / Religious Jews, Ultra-orthodox Jews (UOJ), Arabs, Bedouins, Druze) according to their school's affiliation. Growth and socio-demographic data were extracted for each child from the national Tipat Halav clinics (Family Care Centers) computerized records.

Results: The study included 368,088 children, with a median age of 6.7 (IQR 6.3-7.0). Children with short stature had lower BMI-z scores, lower socio-economic position (SEP) scores, higher SGA and lower LGA rates than controls. Short stature was most prevalent in UOJ boys (3.8%) and girls (3.2%), and least prevalent in Arab boys (0.8%) and girls (0.7%) compared to all other sectors. All between-group comparisons were significant (P <0.001). In a logistic regression model, variables which were predictive of short stature at age 6-7 years were: female sex, greater gestational age at birth, lower height-z at age 0-4 months, birth weight<90^th percentile for gestational age, being in the UOJ sector, and having a lower Δheight-z score during the first 2 years of life.

Table 1: Baseline characteristics according to sex
	Short stature n = 6145, (1.7%)	Normal height n = 361,943, (98.3%)
Sex n (%) Male Female	3237 (1.7) 2908 (1.6)	181,875 (98.3)* 180,068 (98.4)
Height z score Mean (SD) Male Female	-2.38 (0.36) -2.38 (0.38)	0.12 (0.97)* 0.07 (0.94)*
BMI z score Median (IQR) Male Female	-0.33 (-0.83,0.21) -0.28 (-0.69,0.21)	0.04 (-0.54,0.75)* 0.09 (-0.45,0.80)*
SEP cluster Median (IQR) Male Female	2 (1,5) 3 (1,6)	5 (2,7)* 5 (2,7)*
Corrected birth weight Males AGA SGA LGA Females AGA SGA LGA	2965 (91.6) 185 (5.7) 87 (2.7) 2676 (92.0) 175 (6.0) 57 (2.0)	161,044 (88.5)* 2532 (1.4) 18,299 (10.1) 159,373 (88.5)* 2524 (1.4) 18,171 (10.1)
* P <0.001

Conclusion: Understanding the origins of growth gaps and identifying possible nutritional deficits in Israeli children will help to diagnose, prevent and treat future growth impairment.