Associations between High Protein Intake, Linear Growth, and Stunting in Children and Adolescents: A Cross-Sectional Study
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Participants
2.2. Dietary Assessment
2.3. Outcome Assessment
2.4. Covariates
2.5. Statistical Analysis
3. Results
3.1. Characteristics of the Participants
3.2. Association of Protein Intake with Linear Growth in Children and Adolescents
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variables | n | Protein Intake, g·kg−1·d−1 | Protein Intake, %E | Height (cm) | HAZ | Stunning | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
Mean ± SD | p | Mean ± SD | p | Mean ± SD | p | Mean ± SD | p | N (%) | p | ||
Overall | 3299 | ||||||||||
Basic characteristics | |||||||||||
Gender | <0.001 | <0.001 | <0.001 | <0.001 | 0.025 | ||||||
Male | 1837 | 1.82 ± 0.66 | 15% ± 5% | 161.76 ± 13.63 | 0.55 ± 1.00 | 21 (1.14) | |||||
Female | 1462 | 2.03 ± 0.60 | 19% ± 6% | 155.86 ± 9.65 | 0.31 ±0.92 | 31 (2.12) | |||||
Age, years | <0.001 | <0.001 | <0.001 | <0.001 | 0.052 | ||||||
9.0–12.0 | 1074 | 2.44 ± 0.67 | 18% ± 6% | 146.44 ± 8.48 | 0.74 ± 1.06 | 9 (0.84) | |||||
12.0–14.0 | 849 | 1.85 ± 0.48 | 17% ± 5% | 160.44 ± 7.85 | 0.61 ± 1.04 | 18 (2.12) | |||||
>14.0 | 1376 | 1.54 ± 0.37 | 17% ± 5% | 168.16 ± 8.04 | 0.11 ± 0.87 | 25 (1.82) | |||||
Ethnicity | 0.976 | 0.428 | 0.373 | 0.303 | <0.001 | ||||||
Han Chinese | 3177 | 1.91 ± 0.64 | 17% ± 5% | 159.18 ± 12.41 | 0.44 ± 0.97 | 45 (1.42) | |||||
Others | 122 | 1.91 ± 0.62 | 17% ± 6% | 158.16 ± 11.68 | 0.35 ± 1.07 | 7 (5.74) | |||||
Premature | 0.279 | 0.558 | 0.115 | 0.996 | 0.543 | ||||||
Yes | 3123 | 1.91 ± 0.64 | 17% ± 5% | 159.24 ± 12.41 | 0.44 ± 1.02 | 51 (1.63) | |||||
No | 174 | 1.97 ± 0.62 | 17% ± 6% | 156.53 ± 11.58 | 0.44 ± 0.98 | 1 (0.57) | |||||
Missing | 2 | 1.40 ± 0.30 | 14% ± 8% | 165.00 ± 2.69 | 0.50 ± 0.71 | 0 (0.00) | |||||
Birth length, cm | <0.001 | 0.330 | <0.001 | <0.001 | 0.336 | ||||||
Low | 651 | 2.02 ± 0.64 | 17% ± 5% | 156.78 ± 11.96 | 0.28 ± 1.01 | 13 (2.00) | |||||
High | 2648 | 1.89 ± 0.64 | 17% ± 6% | 159.67 ± 12.41 | 0.48 ± 1.02 | 39 (1.47) | |||||
Pubertal stage | 0.667 | <0.001 | <0.001 | 0.815 | |||||||
Pre-puberty | 343 | 2.68 ± 0.71 | <0.001 | 17% ± 5% | 141.37 ± 6.61 | 0.42 ± 0.91 | 5 (1.46) | ||||
Mid-puberty | 887 | 2.26 ± 0.65 | 17% ± 5% | 151.04 ± 9.72 | 0.64 ± 1.06 | 16 (1.80) | |||||
Post-puberty | 2069 | 1.64 ± 0.41 | 17% ± 6% | 165.57 ± 8.66 | 0.36 ± 0.93 | 31 (1.50) | |||||
Household income, CNY/years | 0.569 | 0.929 | 0.720 | <0.001 | 0.372 | ||||||
<120,000 | 935 | 1.90 ± 0.62 | 17% ± 6% | 158.84 ± 11.95 | 0.30 ± 0.97 | 19 (2.03) | |||||
120,000–250,000 | 1126 | 1.90 ± 0.66 | 17% ± 6% | 159.38 ± 12.18 | 0.43 ± 0.98 | 19 (1.69) | |||||
≥250,000 | 1214 | 1.93 ± 0.64 | 17% ± 5% | 159.13 ± 12.87 | 0.56 ± 0.95 | 14 (1.15) | |||||
Missing | 24 | 1.87 ± 0.77 | 17% ± 5% | 160.67 ± 13.78 | 0.18 ± 0.86 | 0 (0.00) | |||||
Smoking status | 0.195 | 0.797 | <0.001 | 0.061 | 0.344 | ||||||
no | 3244 | 1.91 ± 0.64 | 17% ± 6% | 158.99 ± 12.31 | 0.44 ± 1.02 | 52 (1.60) | |||||
yes | 55 | 1.80 ± 0.75 | 17% ± 6% | 165.88 ± 14.14 | 0.22 ± 1.03 | 0 (0.00) | |||||
Drinking status, standard drink/month | <0.001 | <0.001 | <0.001 | 0.109 | 0.166 | ||||||
Never | 2819 | 1.96 ± 0.65 | 17% ± 5% | 158.16 ± 12.35 | 0.46 ± 0.98 | 43 (1.53) | |||||
<1 | 369 | 1.67 ± 0.53 | 16% ± 6% | 163.99 ± 11.11 | 0.34 ± 0.90 | 9 (2.44) | |||||
≥1 | 111 | 1.54 ± 0.39 | 16% ± 6% | 168.19 ± 9.67 | 0.33 ± 0.93 | 0 (0.00) | |||||
MVPA, h/day | <0.001 | <0.001 | <0.001 | <0.001 | 0.035 | ||||||
<1.0 | 770 | 1.79 ± 0.56 | 18% ± 6% | 161.16 ± 11.00 | 0.21 ± 1.00 | 19 (2.47) | |||||
1–3 | 1505 | 1.88 ± 0.61 | 17% ± 5% | 159.91 ± 12.05 | 0.46 ± 1.01 | 21 (1.40) | |||||
>3 | 1010 | 2.04 ± 0.72 | 16% ± 5% | 156.42 ± 13.29 | 0.60 ± 1.02 | 11 (1.09) | |||||
Missing | 14 | 2.26 ± 0.96 | 18% ± 6% | 151.99 ± 16.03 | 0.07 ± 1.27 | 1 (7.14) | |||||
Central obesity | <0.001 | 0.028 | <0.001 | <0.001 | 0.018 | ||||||
No | 2784 | 2.01 ± 0.63 | 17% ± 5% | 158.47 ± 12.41 | 0.32 ± 0.96 | 50 (1.80) | |||||
Yes | 515 | 1.40 ± 0.41 | 17% ± 6% | 162.50 ± 11.62 | 1.09 ± 1.09 | 2 (0.39) | |||||
Length of nighttime sleep, h/day | <0.001 | <0.001 | <0.001 | <0.001 | 0.824 | ||||||
<8 | 635 | 1.52 ± 0.40 | 17% ± 6% | 167.93 ± 8.69 | 0.11 ± 0.88 | 11 (1.73) | |||||
8–9 | 1205 | 1.72 ± 0.49 | 17% ± 5% | 163.91 ± 9.67 | 0.39 ± 1.00 | 21 (1.74) | |||||
≥9 | 1442 | 2.25 ± 0.68 | 18% ± 6% | 151.19 ± 10.97 | 0.64 ± 1.05 | 20 (1.39) | |||||
Missing | 16 | 1.88 ± 0.72 | 16% ± 4% | 159.47 ± 15.31 | 0.00 ± 0.89 | 0 (0.00) | |||||
Protein intake, g·kg−1·d−1 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | ||||||
Q1 | 825 | 1.22 ± 0.19 | 14% ± 5% | 170.23 ± 8.24 | 0.66 ± 1.00 | 3 (0.36) | |||||
Q2 | 824 | 1.64 ± 0.09 | 17% ± 5% | 163.60 ± 8.18 | 0.50 ± 0.94 | 5 (0.61) | |||||
Q3 | 825 | 2.00 ± 0.12 | 18% ± 6% | 157.09 ± 8.44 | 0.43 ± 0.99 | 18 (2.18) | |||||
Q4 | 825 | 2.80 ± 0.49 | 18% ± 5% | 145.66 ± 8.86 | 0.17 ± 0.88 | 26 (3.15) | |||||
Biochemical indexes | |||||||||||
Serum vitamin D3, ng/mL | <0.001 | 0.002 | <0.001 | <0.001 | 0.383 | ||||||
T1 | 1093 | 1.76 ± 0.54 | 18% ± 6% | 162.38 ± 10.49 | 0.29 ± 0.95 | 15 (1.37) | |||||
T2 | 1093 | 1.89 ± 0.61 | 17% ± 6% | 159.54 ± 11.94 | 0.50 ± 1.04 | 22 (2.01) | |||||
T3 | 1094 | 2.08 ± 0.72 | 17% ± 5% | 155.54 ± 13.49 | 0.53 ± 1.05 | 15 (1.37) | |||||
Serum Ca, mmol/L | <0.001 | 0.594 | <0.001 | <0.001 | 0.745 | ||||||
Low | 697 | 1.79 ± 0.55 | 17% ± 5% | 162.11 ± 10.99 | 0.33 ± 0.92 | 12 (1.72) | |||||
High | 2584 | 1.94 ± 0.66 | 17% ± 6% | 158.40 ± 12.60 | 0.47 ± 0.98 | 40 (1.55) | |||||
Serum Zn, mg/L | 0.048 | 0.015 | 0.003 | 0.919 | 0.582 | ||||||
T1 | 1092 | 1.95 ± 0.65 | 17% ± 6% | 158.21 ± 12.25 | 0.45 ± 0.97 | 14 (1.28) | |||||
T2 | 1094 | 1.89 ± 0.64 | 17% ± 5% | 159.41 ± 12.37 | 0.43 ± 0.98 | 20 (1.83) | |||||
T3 | 1093 | 1.89 ± 0.64 | 17% ± 5% | 159.97 ± 12.42 | 0.44 ± 0.97 | 18 (1.65) | |||||
Serum vitamin A, μg/mL | <0.001 | <0.001 | <0.001 | 0.181 | 0.666 | ||||||
T1 | 1087 | 2.10 ± 0.68 | 18% ± 6% | 155.48 ± 12.27 | 0.40 ± 0.93 | 20 (1.84) | |||||
T2 | 1091 | 1.95 ± 0.61 | 17% ± 6% | 158.45 ± 11.76 | 0.44 ± 0.99 | 17 (1.56) | |||||
T3 | 1102 | 1.69 ± 0.56 | 16% ± 5% | 163.59 ± 11.68 | 0.48 ± 0.99 | 15 (1.36) | |||||
Dietary fat intake (g/d) | <0.001 | <0.001 | <0.001 | 0.137 | 0.241 | ||||||
T1 | 1100 | 1.69 ± 0.56 | 15% ± 5% | 160.16 ± 13.03 | 0.48 ± 0.98 | 14 (1.27) | |||||
T2 | 1099 | 1.97 ± 0.61 | 19% ± 5% | 157.88 ± 12.02 | 0.40 ± 0.97 | 15 (1.36) | |||||
T3 | 1100 | 2.08 ± 0.69 | 18% ± 5% | 159.40 ± 11.97 | 0.44 ± 0.97 | 23 (2.09) | |||||
Dietary carbohydrate intake (g/d) | <0.001 | <0.001 | <0.001 | 0.040 | 0.431 | ||||||
T1 | 1100 | 2.11 ± 0.69 | 18% ± 5% | 159.36 ± 12.07 | 0.46 ± 0.98 | 19 (1.73) | |||||
T2 | 1099 | 1.95 ± 0.60 | 19% ± 5% | 158.05 ± 11.95 | 0.38 ± 0.97 | 20 (1.82) | |||||
T3 | 1100 | 1.67 ± 0.55 | 14% ± 5% | 160.02 ± 13.03 | 0.48 ± 0.96 | 13 (1.18) | |||||
Parental characteristics | |||||||||||
Fathers’ height, cm | 0.047 | 0.283 | <0.001 | <0.001 | <0.001 | ||||||
Q1 | 680 | 1.96 ± 0.67 | 17% ± 6% | 157.01 ± 12.48 | −0.00 ± 0.92 | 31 (4.56) | |||||
Q2 | 1031 | 1.93 ± 0.64 | 17% ± 6% | 158.44 ± 12.01 | 0.27 ± 0.90 | 14 (1.36) | |||||
Q3 | 721 | 1.89 ± 0.60 | 17% ± 5% | 159.79 ± 11.73 | 0.61 ± 0.90 | 2 (0.28) | |||||
Q4 | 824 | 1.88 ± 0.65 | 17% ± 5% | 161.14 ± 13.00 | 0.87 ± 0.94 | 4 (0.49) | |||||
Missing | 43 | 1.78 ± 0.68 | 17% ± 6% | 160.93 ± 11.78 | 0.47 ± 0.90 | 1 (2.33) | |||||
Mothers’ height, cm | <0.001 | 0.158 | <0.001 | <0.001 | <0.001 | ||||||
Q1 | 834 | 1.99 ± 0.66 | 17% ± 6% | 156.44 ± 11.97 | 0.05 ± 0.92 | 29 (3.48) | |||||
Q2 | 674 | 1.95 ± 0.63 | 17% ± 5% | 157.51 ± 12.09 | 0.29 ± 0.91 | 12 (1.78) | |||||
Q3 | 939 | 1.87 ± 0.63 | 17% ± 6% | 160.56 ± 12.03 | 0.54 ± 0.93 | 8 (0.85) | |||||
Q4 | 827 | 1.85 ± 0.63 | 17% ± 5% | 161.57 ± 12.71 | 0.85 ± 0.94 | 3 (0.36) | |||||
Missing | 25 | 2.12 ± 0.84 | 18% ± 6% | 160.28 ± 13.37 | 0.28 ± 0.86 | 0 (0.00) | |||||
Fathers’ education, years | <0.001 | 0.557 | 0.021 | <0.001 | 0.006 | ||||||
≤9 years | 605 | 1.84 ± 0.57 | 17% ± 5% | 160.19 ± 11.10 | 0.18 ± 0.97 | 17 (2.81) | |||||
10~12 years | 764 | 1.88 ± 0.64 | 17% ± 6% | 159.61 ± 12.48 | 0.32 ± 0.97 | 16 (2.09) | |||||
13~15 years | 941 | 1.91 ± 0.62 | 17% ± 6% | 158.82 ± 12.25 | 0.49 ± 0.97 | 13 (1.38) | |||||
≥16 years | 948 | 2.00 ± 0.70 | 17% ± 5% | 158.33 ± 13.16 | 0.66 ± 0.93 | 5 (0.53) | |||||
Missing | 41 | 1.75 ± 0.67 | 17% ± 6% | 161.44 ± 11.77 | 0.45 ± 0.89 | 1 (2.44) | |||||
Mothers’ education, years | <0.001 | 0.182 | <0.001 | <0.001 | <0.001 | ||||||
≤9 years | 721 | 1.81 ± 0.56 | 17% ± 6% | 160.19 ± 11.40 | 0.17 ± 0.98 | 23 (3.19) | |||||
10~12 years | 921 | 1.87 ± 0.62 | 17% ± 6% | 159.88 ± 12.36 | 0.40 ± 0.97 | 16 (1.74) | |||||
13~15 years | 923 | 1.96 ± 0.66 | 17% ± 5% | 158.81 ± 12.60 | 0.52 ± 0.97 | 12 (1.30) | |||||
≥16 years | 714 | 2.01 ± 0.70 | 17% ± 5% | 157.44 ± 12.89 | 0.67 ± 0.90 | 1 (0.14) | |||||
Missing | 20 | 1.95 ± 0.78 | 18% ± 7% | 163.55 ± 12.36 | 0.26 ± 0.80 | 0 (0.00) | |||||
Mothers’ age, years | <0.001 | 0.818 | <0.001 | <0.001 | 0.350 | ||||||
T1 | 1044 | 2.12 ± 0.70 | 17% ± 5% | 153.67 ± 12.05 | 0.55 ± 1.05 | 15 (1.44) | |||||
T2 | 950 | 1.92 ± 0.60 | 17% ± 6% | 159.64 ± 11.69 | 0.44 ± 1.01 | 12 (1.26) | |||||
T3 | 1267 | 1.74 ± 0.56 | 17% ± 6% | 163.11 ± 11.49 | 0.37 ± 0.99 | 25 (1.97) |
Models | Protein Intake, g·kg−1·d−1 | Protein Intake, %E | ||||||
---|---|---|---|---|---|---|---|---|
Body Height | HAZ | Body Height | HAZ | |||||
β (95%CI) | p | β (95%CI) | p | β (95%CI) | p | β (95%CI) | p | |
Crude model | −9.45 (−9.72, −9.18) | <0.001 | −0.21 (−0.25, −0.18) | <0.001 | −2.20 (−2.61, −1.78) | <0.001 | −0.09 (−0.12, −0.05) | <0.001 |
Model I | −5.79 (−6.12, −5.45) | <0.001 | −0.78 (−0.83, −0.73) | <0.001 | −0.50 (−0.72, −0.28) | <0.001 | −0.04 (−0.07, −0.01) | 0.018 |
Model II | −5.78 (−6.12, −5.45) | <0.001 | −0.79 (−0.84, −0.74) | <0.001 | −0.48 (−0.70, −0.26) | <0.001 | −0.04 (−0.07, −0.01) | 0.014 |
Pubertal Stage | Boys | Girls | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
n | Body Height | HAZ | n | Body Height | HAZ | |||||
β (95%CI) | p | β (95%CI) | p | β (95%CI) | p | β (95%CI) | p | |||
Pre-puberty | 266 | −3.92 (−4.52, −3.32) | <0.001 | −0.61 (−0.71, −0.50) | <0.001 | 77 | −3.97 (−5.54, −2.40) | <0.001 | −0.60 (−0.88, −0.31) | <0.001 |
Mid-puberty | 580 | −6.53 (−7.15, −5.91) | <0.001 | −0.94 (−1.03, −0.84) | <0.001 | 307 | −4.69 (−5.45, −3.93) | <0.001 | −0.77 (−0.90, −0.64) | <0.001 |
Post-puberty | 991 | −5.82 (−6.55, −5.08) | <0.001 | −0.73 (−0.83, −0.62) | <0.001 | 1078 | −4.79 (−5.38, −4.20) | <0.001 | −0.69 (−0.79, −0.60) | <0.001 |
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Xiong, T.; Wu, Y.; Hu, J.; Xu, S.; Li, Y.; Kong, B.; Zhang, Z.; Chen, L.; Tang, Y.; Yao, P.; et al. Associations between High Protein Intake, Linear Growth, and Stunting in Children and Adolescents: A Cross-Sectional Study. Nutrients 2023, 15, 4821. https://doi.org/10.3390/nu15224821
Xiong T, Wu Y, Hu J, Xu S, Li Y, Kong B, Zhang Z, Chen L, Tang Y, Yao P, et al. Associations between High Protein Intake, Linear Growth, and Stunting in Children and Adolescents: A Cross-Sectional Study. Nutrients. 2023; 15(22):4821. https://doi.org/10.3390/nu15224821
Chicago/Turabian StyleXiong, Ting, Yuanjue Wu, Jiazhen Hu, Shiqi Xu, Yan Li, Binxuan Kong, Zhuangyu Zhang, Liangkai Chen, Yuhan Tang, Ping Yao, and et al. 2023. "Associations between High Protein Intake, Linear Growth, and Stunting in Children and Adolescents: A Cross-Sectional Study" Nutrients 15, no. 22: 4821. https://doi.org/10.3390/nu15224821
APA StyleXiong, T., Wu, Y., Hu, J., Xu, S., Li, Y., Kong, B., Zhang, Z., Chen, L., Tang, Y., Yao, P., Xiong, J., & Li, Y. (2023). Associations between High Protein Intake, Linear Growth, and Stunting in Children and Adolescents: A Cross-Sectional Study. Nutrients, 15(22), 4821. https://doi.org/10.3390/nu15224821