Whole-population Perspective is Needed for Analyses and Actions to Address Linear Growth Faltering in Low- and Middle-Income Countries

Linear growth faltering (LGF), or slower than normal growth in height, is widely considered an indicator of suboptimal conditions affecting children's development and health in low- and middle-income countries (LMICs). Recently, Benjamin-Chung and collaborating members of the Healthy Birth, Growth and Development Knowledge integration (HBGDki) consortium described the early onset and low reversal rates of LGF in 32 cohort studies that followed over 52,000 children from birth to 24 months of age in 14 countries. Their adoption and extension of conventionally used growth metrics to describe faltering patterns led to findings that echo a long-standing assumption that LGF in resource-constrained settings occurs mainly during early infancy and is mostly irreversible thereafter. Here, we discuss limitations of their methods and suggest an alternative approach that leads to different conclusions about the rate and timing of LGF in LMICs. ### Competing Interest Statement Daniel E. Roth and Diego G. Bassani were funded by the HBGDki initiative between June 8th 2015 and Jan 31st 2017 (OPP1133178). ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The code used to generate the simulated datasets used in this analysis is available at https://github.com/DiegoGBassani/Linear\_growth\_faltering. [https://github.com/DiegoGBassani/Linear\_growth\_faltering][1] [1]: https://github.com/DiegoGBassani/Linear_growth_faltering