Short Stature in Iran

Abstract

Public health programs have succeeded in many achievements in Iran over the past two decades. Now, Iranians’ health indicators generally exceed most regional averages. A health-care network serves the integrated program of primary health for Iranian families residing in rural and urban areas. Presently in the absence of growth charts that are specifically constructed for Iranian children and adolescents, physicians and health-care services use NCHS charts for growth monitoring and assessing height status in pediatric population. 11% of Iranian urban children less than 5 years of age and 21.8% of their rural peers have moderate to severe stunting. Short stature most commonly presents between 12 and 23 months of age, when its prevalence is considerably greater in rural (27.3%) than in urban (13.9%) areas. According to different reports from various parts of the country, 45–85.5% of diagnosed short statures have been due to non-pathologic causes. Growth hormone deficiency (GHD) is the most common endocrine cause of short stature in Iran, followed by hypothyroidism as the second common etiology. The rates of GHD and hypothyroidism among Iranian short children range from 6 to 30% and 2.5 to 12%, respectively. The heights of about 45% of patients with beta-thalassemia major in Iran are 2 SD below the mean for age and sex based on NCHS growth charts. The prevalence of short stature in thalassemic patients increases progressively with advancing age. Zinc deficiency is one of the most prevalent micronutrient insufficiencies in developing countries, including Iran. Its prevalence varies in different parts of Iran; nevertheless, it is more common in rural areas, correlating with the rate of stunting. Turner syndrome is the most common chromosomal abnormality associated with short stature that comprises about 1.3–13.5% of short girls referred to pediatric endocrinology clinics in Iran. Although the most common problem encountered by Iranian pediatric endocrinologists is short stature, about 35% of children referred to pediatric endocrinologists for evaluation of short stature are not truly short but rather have a normal growth velocity. Short stature is still a major endocrine problem in Iran; however, it seems that the stature of Iranian children has been improving over the last decades. During 1990s the average height of Iranian girls and boys between 2 and 18 years of age has increased about 3.6 cm.