1. Tanner Stage II
Tanner Stage III
Tanner Stage IV
Tanner Stage III
Tanner Stage IV
Tanner Stage V
Tanner Stage II
Tanner Stage I
Potential of Catch-up Growth in Height during Puberty
Arlin Cherian, Susan Campisi, Michelle Gaffey, Dr. Zulfiqar Bhutta
Centre for Global Child Health, The Hospital for Sick Children
BACKGROUND
Linear growth retardation largely accrues during the first 1000 days
of life, affecting physical and cognitive development from early
childhood to adulthood.
 Stunting, defined as linear growth retardation is an inadequate
height-for-age with (HAZ -2 SD).
 It affects approximately 161 million children (2013) under the
age of 5 years.
 Approximately, 34.2% of this population resides in Africa, with
25.3% in Asia and 12.4% in Latin America and the Caribbean.
 The World Health Organization aims to achieve their target of
reducing stunting by 40% by 2025.
Known Causes:
 Inadequate nutrition
 Diarrheal infections
 Environmental and socioeconomic factors (Poverty, inadequate
resources, lack of education).
Linear Retardation Outcomes:
 Poor productivity
 Less capital output
 Increased rates of morbidity and mortality in low and middle-
income countries.
Catch-Up Growth (CUG):
 Accelerated growth above normal rates following a period of
growth faltering to resume to their pre-illness growth curve.
 A form of stunting recovery to measure if interventions in pre-
puberty or adolescent stages are effective.
MOTIVATION
OBJECTIVES
The main objectives of this review is to:
I. To accrue the definition of CUG in height from various contexts,
such as stunting recovery from severe malnutrition, SGA, disease
causing linear retardation as well as in adoption and migration
studies.
II. To understand the mechanism and potential of CUG in relation to
the timing of puberty onset, pubertal growth spurt and sexual
maturity.
III. To identify interventions with either a positive or negative effect that
may be extrapolated for scaling up in countries of high stunting
burden.
RESULTS
METHODOLGY INCLUSION/ EXCLUSION
CRITERIA
CONCLUSIONS
 CUG in height is possible during puberty, but occurs differently in boys
and girls with linear growth retardation.
 The principle mechanism appeared to be delayed onset of puberty,
allowing a longer period of CUG during adolescence.
 Other possible reasons for CUG during adolescence: genetic
predisposition, canalization of growth (Tanner’s mechanism), degree of
early childhood stunting and recovery and maternal height and nutrition,
environmental influences (migration, adoption) and disease recovery .
 Better final height with CUG is observed when intervention occur pre-
pubertal/ early puberty (Tanner stage I & II).
 Further research on impact of interventions as well as CUG during
adolescence needs to be assessed.
 CUG during adolescence may assist breaking the intergenerational cycle
of stunting and its consequences.
Two critical periods of rapid growth exist: early childhood and
adolescence. Traditionally, research and interventions focused on the
first 2 years of life to capitalize on this period of rapid growth. Evidence
based research on the potential of CUG during puberty in adolescence is
minimal. This narrative review summarizes the biological plausibility of
linear CUG during puberty using appropriate existing literature.
INCLUSION EXCLUSION
Primary studies (population, birth
cohorts, longitudinal)
Systematic reviews
Adolescents aged 7- 19y
CUG in height only
Language criteria: English Only
Marginally or severely stunted
(HAZ<- 2SD)
 CUG in infants, toddlers, 0-5yrs
 Animal studies
 CUG in weight, BMI, skinfold
measurements
Figure 1: The stunting syndrome and its consequences
during different life stages.
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
GirlsBoys
Figure 2: Age range of CUG in height during pre-puberty and/ or puberty.
GirlsBoys
Precocious Puberty
Early Puberty
Normal Puberty
Delayed Puberty
(Mean age 11.2y
(Mean age 11.6y)
Tanner Stage I
Tanner Stage V
Figure 3: Tanner Sexual Maturity Staging and trends of puberty onset in boys and girls
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Contact Info: Arlin Cherian
arlin.cherian@sickkids.ca