Hindawi Evidence-Based Complementary and Alternative Medicine Volume 2021, Article ID 3933854, 6 pages https://doi.org/10.1155/2021/3933854

Research Article Analysis of Prevalence, Influencing Factors, and Countermeasures of Short Stature in Children and Adolescents Aged 6∼14 in Furong , City, in 2020

Yanyan Li,1 Yun Chen,2 Xuan Xu,1 Boyu Tan,1 Yingbo Liu,1 Xuan Peng,1 Danxia Peng,1 Shuping Liu,1 and Jinghui Yao 2

1Department of Pediatric Endocrinology, Genetic Metabolism and Cardiology, Provincial People’s Hospital ("e First Affiliated Hospital of Hunan Normal University), No. 61, Liberation West Jiefang Road, Furong District, Changsha 410006, Hunan, 2Department of Pediatric Orthopedics, Center for Orthopaedic Surgery, "e "ird Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, China

Correspondence should be addressed to Jinghui Yao; [email protected]

Received 19 July 2021; Accepted 26 July 2021; Published 9 August 2021

Academic Editor: Songwen Tan

Copyright © 2021 Yanyan Li et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In recent years, children’s and adolescents’ growth and development issues have received increasing attention with the so- cioeconomic development. +e etiology of child short stature involves heredity, race, sex, nutrition, and a variety of endocrine hormones, which is very complex. +e age of 6∼14 is the key period of children’s development. Understanding the height characteristics, the prevalence of short stature, and its influencing factors at this stage and formulating preventive measures as soon as possible are conducive to improving the average height of children and reducing the incidence of short stature. In this study, cluster sampling was used to select 56,865 children and adolescents aged 6∼14 years old from 40 primary and secondary schools in Furong District of Changsha City, and the height of each child and adolescent was measured. +e results showed that the overall crude prevalence of short stature in children aged 6∼14 in Furong District of Changsha is 2.82%. Growth hormone level <10 μg/L, pubertal retardation, familial short stature, low egg intake, and intrauterine growth retardation are independent risk factors affecting the occurrence of short stature. In order to improve the status quo of short stature of children aged 6∼14 in Furong District, Changsha City, targeted intervention should be strengthened for people with combined high risk factors.

1. Introduction of behavioral adaptation disorder, stunted puberty, mental retardation, and psychological barrier [3]. In addition, the Short stature (SS) refers to children of the same race, sex, and incidence of chronic cardiopulmonary insufficiency and age whose height is 2 standard deviations lower than the neurological dysfunction in children will also increase. average height of normal population or lower than the 3rd +erefore, it is of great significance to diagnose short stature percentile in similar living environment, which is a common as early as possible and give appropriate and systematic disease in pediatrics [1]. Epidemiology shows that the total treatment according to the etiology to improve the clinical detection rate of short stature in children in Suzhou area is symptoms and improve the quality of life of children. 2.89%, the prevalence rate of short stature in children in +e etiology of short stature in children is complex and Wuhan is 5.47%, and that in Yizheng was 2.2% [2]. It can be involves genetics, race, gender, nutrition, and various en- seen that the incidence of short stature in children in China docrine hormones [4]. In order to further clarify the is high. Studies have found that short stature will not only prevalence of short stature among children and adolescents affect the height of children but also lead to varying degrees in Furong District of Changsha, this study investigated the 2 Evidence-Based Complementary and Alternative Medicine height distribution characteristics of primary and middle than 10 μg/L. (iv) Height increased by less than 5.0 cm/year. school students in this area and analyzed possible risk factors (v) Turner syndrome. (vi) Hypothyroidism. (vii) +e average in order to provide scientific basis and countermeasures for height of parents being less than 155.0 cm. clinical treatment. 2.6. Statistical Methods. All data were processed with SPSS 2. Materials and Methods 22.0 statistical software, and GraghPad prism 8 was used to 2.1. General Information. A total of 56,865 students aged make statistical graphs. In order to ensure the accuracy of the 6∼14 from 40 primary and secondary schools in Furong data, double entry was recorded during the survey. Mea- District of Changsha were selected as the research objects surement data are expressed as mean ± standard deviation from September to October, 2020, by cluster sampling (x ± s), independent sample t-test is used for comparison between groups, count data is expressed as (n (%)), and chi- method. Each person issued a questionnaire on factors re- 2 lated to short stature, a total of 56,865 copies were issued. square (χ ) test is performed. Multivariate logistic regression model was used to analyze the related factors affecting the short stature in children. +e difference is statistically sig- 2.2. Inclusion Criteria. (i) +e age of 6∼14 years old; (ii) with nificant when P < 0.05. no congenital organ loss; (iii) sound limbs; (iv) Han na- tionality; (v) the permanent resident population of Furong 3. Results District, Changsha City. 3.1. Basic Situation. In this study, a total of 56,865 primary and secondary school students were sampled and investi- 2.3. Exclusion Criteria. (i) Diseases affecting growth and gated, of which 2,848 were younger than 6 or older than 14 development, such as digestive system diseases, urinary years old, 243 were incomplete for height information filling, system diseases, and iron deficiency anemia; (ii) mental and 53,772 were finally included after exclusion. retardation; (iii) patients who were administrated with drugs that inhibited bone marrow or erythropoietin within six months before enrollment; (iv) patients who had heart, 3.2. Height Distribution Characteristics of Various Age brain, liver, kidney, and other vital organ dysfunction. Groups. +e average height of male students in the age group of 6∼8 is higher than that of female students. +e average height of female students in the age group of 9∼11 is 2.4. Method slightly higher than that of male students. +e average height 2.4.1. Collecting the Data. Parents completed the ques- of male students in the age group of 12∼14 surpasses that of tionnaires based on the content of the survey and the specific female students, as shown in Figure 1. circumstances of their own children. +e main investigation contents included paternal height, maternal height, the 3.3.Comparison withNationalStudent Physical HealthSurvey manner of delivery, birth weight, the history of genetic Results in 2014. +e results of this survey show that the diseases, egg intake, milk intake, meat intake, sleep time at average height of middle school students aged 6∼14 in night, and weekly exercise frequency. Furong District has little difference with the average height of the national students in 2014. +e average height of 12∼14 2.4.2. Physical Examination Requirements. +e physical years old group in Furong District is slightly higher than the examination was conducted according to the Project of national average height of students, and it was more obvious Health Checklist for Primary and Middle School Students in the group of boys (Table 1). [5]. +e method of height measurement referred to the requirements of National Standards for Students’ Physique 3.4. Crude Prevalence of Short Stature. A total of 1,517 of [6]and Administrative Measures for Physical Examination 53,772 primary and middle school students suffer from short of Primary and Secondary School Students [7]. +e testee stature, and the overall crude prevalence rate of short stature must take off his/her shoes when measuring the height. +e is 2.82%. Among them, the prevalence rate of male short requirements for the posture include standing upright, stature was 2.62%, while that of female was 3.05%, and there keeping head, hip, and heel abut against the measuring was no statistical difference between male and female groups column at three points, and looking ahead with both eyes. (P > 0.05) (Table 2). +e height of all study subjects is the average of 3 repeated measurements, and the reading must be accurate to 0.1 cm. 3.5. Univariate Analysis of Occurrence of Short Stature. Univariate analysis showed that the age, intrauterine growth 2.5. Diagnostic Criteria for Short Stature [8]. If the following retardation, maternal height, and daily milk intake in the two or more indicators are met, it can be diagnosed as short diseased group were not statistically significant compared stature: (i) the height being lower than the average height of with those of the nondiseased group (P > 0.05). But there normal people by 2 standard deviations. (ii) +e imaging test were differences in gender, growth hormone level, pubertal showing that the bone age is more than 2 years behind the retardation, hypothyroidism, the occurrence of Turner actual bone age. (iii) +e level of growth hormone being less syndrome, familial short stature, paternal height, egg intake, Evidence-Based Complementary and Alternative Medicine 3

180 female group had a slightly higher average height than the national level at the age of 10∼14 years. 170 Short stature is a common public health problem in de- 160 veloping countries. Our study conducted a statistical analysis on 150 the prevalence of dwarfism among primary and middle school students aged 6∼14 in Furong District, Changsha City. +e 140 results showed that the gross prevalence rate of short stature was 130 2.82%, which was significantly lower than that of short stature

Te average height (cm) published by WHO in developing countries (32.5%) [10]. It is 120 also lower than the overall prevalence of short stature in 110 Shanghai (3.77%) [11], Wuhan (5.47%) [12], and Rong’an 678910 11 12 13 14 County (8.0%) [13], which may be closely related to genetics, Age (years) regional economic level, ethnicity, dietary nutrition, endocrine Female hormone levels, and other factors. Male Short stature not only causes physical deficits in the Figure affected children but also brings great psychological impact 1: Height distribution characteristics of various age groups. on children, which is not conducive to healthy growth [14]. +e average height of male students in the age group of 6∼9 is higher than that of female students. +e average height of female +e result of our study showed that growth hormone level students in the age group of 9∼11 is slightly higher than that of male <10 μg/L, pubertal retardation, familial dwarfism, low egg students. +e average height of male students in the age group of intake, and intrauterine growth retardation were indepen- 12∼14 surpasses that of female students. dent risk factors for dwarfism (P > 0.05). Reasons for this include the following: (i) the growth hormone receptor gene is closely related to the occurrence of short stature. Previous exercise status, and the occurrence of intrauterine retar- studies have shown that the growth hormone receptor gene dation between the disaffected group and the nondiseased mutation will affect the growth hormone and the receptor P . group ( > 0 05) (Table 3). binding, and then cause signaling disorders, affect the function of growth hormone, and impede growth and de- 3.6. Variable Assignment. Whether short stature occurred velopment [15]. (ii) Adolescent developmental delay, which was taken as the dependent variable, and the factors with means that no secondary sexual characteristics appear at the significant differences in Table 3 were taken as the inde- age of 13 in girls or 14 in boys, may affect height devel- pendent variables to be included in the logistic regression opment to some extent [16]. (iii) Inheritance is decisive for model. +e assignment of the dependent variables and in- child growth and development, and individuals with short dependent variables is shown in Table 4. stature in an immediate family have a much higher incidence of this condition than those without a family history of short stature [17]. (iv). +e acquired nutrition intake is the key to 3.7. Multivariate Analysis of Occurrence of Short Stature. determine the growth and development of children. Eggs are Growth hormone level <10 μg/L, pubertal retardation, fa- rich in high-quality protein groups, which contain amino milial dwarfism, low egg intake, and intrauterine growth acids such as leucine, isoleucine, lysine, and methionine, retardation were independent risk factors for dwarfism which can maintain life and growth [18]. (v). Full-term (P > 0.05) (Table 5). infants with body weight less than 2,500 g or birth length less than 47 cm are defined as having intrauterine growth re- 4. Discussion tardation. Studies suggest that the population which has growth-related endocrine abnormalities and insensitivity to Height is derived from the longitudinal growth index of growth hormone has a much higher chance of developing human body, which is influenced by heredity, nutrition, short stature in childhood than in normal population [19]. sleep, sports, living environment, living habits, race, etc. [9]. +ere are many drugs for short stature, including In this study, the average height of girls at the age of 9∼11 recombinant human growth hormone (rhGH), gonadotropin- was higher than that of boys at the age of 9∼11 in Furong releasing hormone analogs (GnRHA), aromatase inhibitors District of Changsha City, and the average height of boys at (AI), insulin-like growth factor 1 (IGF-1), protein assimilation the age of 12∼14 surpassed that of girls. +is phenomenon hormones, and traditional Chinese medicine [20]. However, accords with general physiology, growth, and development there is no uniform protocol for the treatment of short stature rule. Due to the inability to obtain the standard deviation of at present, so it is necessary to develop a series of preemptive each age group in the country and the inability to calculate measures. First of all, the relevant institutions need to the statistical parameter values, the difference values were strengthen the education of knowledge related to prenatal and compared with the results of the National Student Physical postnatal care. +ey must actively carry out prenatal screening, Health Survey in 2014. +e results show that the average promote prenatal genetic diagnosis, and avoid the birth of height of male schoolchildren in the age group of 12∼14 children with genetic tendency of short stature as far as pos- years was slightly higher than the national average height of sible. Secondly, pregnant women need to strengthen nutrition schoolchildren in the corresponding age range, and the during pregnancy to avoid the birth of children with 4 Evidence-Based Complementary and Alternative Medicine

Table 1: Comparison of average height of 6–14-year-old primary and middle school students in Furong District of Changsha City in 2020 and national student physical health data in 2014 (cm). Average height of males Average height of females Group Furong District National D-value Furong District National D-value 6∼6.9 120.66 119.7 0.96 119.10 118.1 1.00 7∼7.9 126.09 126.6 −0.51 124.77 125.1 −0.33 8∼8.9 131.55 132.0 −0.45 130.60 130.5 0.10 9∼9.9 137.10 137.2 −0.10 137.05 136.3 0.75 10∼10.9 142.44 142.1 0.34 143.98 142.6 1.38 11∼11.9 148.78 148.1 0.68 150.24 149.3 0.94 12∼12.9 155.86 154.5 1.36 155.10 153.7 1.40

Table 2: Crude prevalence rate of short stature in boys and girls of different age groups in Furong District, Changsha, in 2020 (n, %). Group Males Females Prevalence rate χ2 P value 6 69/3545 (1.95%) 127/3213 (3.95%) 196/6758 (2.9%) 24.09 1.00 7 92/4020 (2.29%) 133/3694 (3.6%) 225/7714 (2.92%) 11.70 0.999 8 97/4275 (2.27%) 122/3692 (3.3%) 219/7967 (2.75%) 7.95 0.995 9 92/3708 (2.48%) 99/3312 (2.99%) 191/7020 (2.72%) 1.71 0.808 10 119/3658 (3.25%) 89/3246 (2.74%) 208/6904 (3.01%) 1.54 0.785 11 115/3650 (3.15%) 59/2917 (2.02%) 174/6567 (2.65%) 8.00 0.995 12 80/2080 (3.85%) 31/1771 (1.75%) 111/3851 (2.88%) 15.01 1.00 13 86/3721 (2.31%) 107/3270 (3.27%) 193/6991 (2.76%) 5.98 0.985

Table 3: Univariate analysis of occurrence of short stature. Clinical information Diseased group (n � 1517) Nondiseased group (n � 52255) χ2/t P value Gender Male 750 (49.44) 27817 (53.23) 8.938 0.003 Female 767 (50.56) 24348 (46.59) Age (years old) 9.41 ± 2.31 9.36 ± 2.39 0.804 0.421 Growth hormone level ＜10 μg/L 1026 (67.63) 12109 (23.17) 1578.586 0.000 ≥10 μg/L 491 (32.37) 40146 (76.83) Pubertal retardation Yes 1043 (68.75) 10374 (19.85) 21007.933 0.000 No 474 (31.25) 41881 (80.15) Intrauterine growth retardation Yes 59 (3.89) 2103 (4.02) 0.070 0.792 No 1458 (96.11) 50152 (95.98) Hypothyroidism Yes 549 (36.19) 65989 (12.63) 710.231 0.000 No 968 (63.81) 45657 (87.37) Turner syndrome Yes 161 (10.61) 1173 (2.24) 426.718 0.000 No 1356 (89.39) 51082 (97.76) Familial short stature Yes 992 (65.39) 6149 (11.77) 3681.029 0.000 No 525 (34.61) 46106 (88.23) Paternal height 156.56 ± 14.37 173.41 ± 16.79 38.679 0.000 Maternal height 150.36 ± 10.12 150.42 ± 10.69 0.216 0.829 Egg intake Occasionally or not 571 (37.64) 3054 (5.84) 2791.266 0.000 Less than once a week 454 (29.93) 8616 (16.49) 1–2 times a week 296 (19.51) 17119 (32.76) 3–5 times a week 196 (12.92) 23466 (44.91) Daily milk intake ＜250 mL 491 (32.37) 17471 (33.43) 4.590 0.101 250–500 mL 546 (35.99) 17440 (33.37) ＞500 mL 480 (31.64) 17344 (33.19) Exercise status Never 175 (11.54) 5413 (10.36) 39.989 0.000 ≤1 times 378 (24.92) 9946 (19.03) 2–3 times 426 (28.08) 15679 (30.00) ≥4 times 538 (35.46) 21217 (40.60) Evidence-Based Complementary and Alternative Medicine 5

Table 4: Variable assignment table. Variable +e assignment Dependent variable Short stature No � 0, yes � 1 Independent variables Gender No � 0, yes � 1 Growth hormone level <10 μg/L � 0, ≥10 μg/L � 1 Pubertal retardation No � 0, yes � 1 Hypothyroidism No � 0, yes � 1 Turner syndrome No � 0, yes � 1 Familial short stature No � 0, yes � 1 Egg intake occasionally or not 1∼2 times a week or 3∼5 times a week � 0, occasionally or not or less than once a week � 1 Exercise status never or once in a while 2∼3 times or ≥4 times � 0, never or ≤1 times � 1 Paternal height Input as actual height Intrauterine growth retardation No � 0, yes � 1

Table 5: Multivariate analysis of occurrence of short stature. Factors β SE Wald χ2 P value OR OR 95% CI Gender 2.354 2.643 25.656 0.591 16.2621 0.349–6.318 Growth hormone level <10 μg/L 3.519 0.474 26.216 0.000 20.593 4.599–1.379 Pubertal retardation 1.374 0.243 12.262 0.000 6.891 1.896–1.064 Hypothyroidism 1.256 1.135 11.953 0.064 6.159 0.948–4.565 Turner syndrome 1.065 1.158 11.049 0.071 6.005 0.285–8.351 Familial short stature 0.346 0.291 0.479 0.000 0.874 1.463–1.258 Egg intake occasionally or not 0.686 0.176 0.716 0.000 0.943 1.634–1.279 Exercise status never or ≤1 times 0.169 0.436 0.297 0.504 0.346 0.341–1.588 Paternal height −0.907 0.359 20.695 0.132 0.163 0.476–2.154 Intrauterine growth retardation 1.676 0.474 10.595 0.000 7.198 1.956–1.533 intrauterine growth retardation due to malnutrition. Most Disclosure importantly, it is necessary to carry out health education for people with combined risk factors and advocate them to keep Yanyan Li and Yun Chen are co-first authors. scientific diet habits, and actively exercise, and then promote growth and development. Conflicts of Interest Due to the limitation of research conditions, this study only conducted a general survey of primary and middle school +e authors declare no conflicts of interest, financial or students in Furong District, and the results of cluster sampling otherwise. may be slightly higher than random sampling. +erefore, the results of this study may not be fully representative of the overall situation of primary and secondary school students in the whole Authors’ Contributions urban area of Changsha, so the results should be interpreted Yanyan Li, Yun Chen, Xuan Xu, Boyu Tan, Yingbo Liu, Xuan with caution. In summary, the overall crude prevalence of short Peng, Danxia Peng, and Shuping Liu carried out specific stature in children aged 6∼14 in Furong District of Changsha is questionnaire surveys and analyzed the data. Yanyan Li and 2.82%. Growth hormone level <10 μg/L, pubertal retardation, Yun Chen wrote the manuscript. Jinghui Yao directed the familial short stature, low egg intake, and intrauterine growth progress of the project and modified the language expression of retardation are independent risk factors affecting the occurrence the manuscript. Yanyan Li and Yun Chen contributed equally of short stature. In order to improve the status quo of short to this article and are the co-first authors. stature of children aged 6–14 in Furong District, Changsha City, targeted intervention should be strengthened for people with combined high risk factors. Acknowledgments +is research was supported by the Renshu Foundation of Data Availability Hunan Provincial People’s Hospital (No. rs201914), Guangdong Provincial Science and Technology Program +e datasets used and analyzed during the current study are (2019a141405032), and Science Popularization Fund Plan of available from the corresponding author and the first au- Guangzhou Association for Science and Technology thors on reasonable request. (k20200602). 6 Evidence-Based Complementary and Alternative Medicine

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