Mean adult height can be used as a cumulative indicator of social conditions and the standard of living of a population [1, 2]. The secular trend of mean adult height of a population is frequently used to explore the evolution or increase in social conditions, including social and economic development over a period of time [1, 3, 4]. Attained adult height is influenced by diverse factors related to human growth at different developmental stages [2]. These determinant factors are classified at three analytical levels: individual, household and environmental level, providing a conceptual framework to explore differences in adult height [2, 3].
The individual level contains biological factors of human growth, including biochemical factors genetics, nutrition and health [5,6,7,8]. An optimal nutrition enables post-natal growth [5, 9, 10], while ill-health episodes experienced during childhood can have a negative effect on nutrient absorption [3]. Individual-level factors associated with growth are likely to be interrelated with household-level factors [11]. Previous research identified social and economic factors observed at household level associated with differences in adult height [2, 12, 13]. Increased mean adult height is observed among women of higher socio-economic status [14, 15]. The environmental factors consider the social and physical conditions in which people live, including cultural, macroeconomic and political factors [7]. Differences in adult height can be observed in relation to historical events such as famine, specific socio-economic periods and the psychosocial context [4, 16, 17].
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The secular trend of adult height can be related to the social development experienced by the society in a given time period [1]. The secular trend explores the annual rate of change, providing evidence about the magnitude of the height growth over time. Previous research has identified that the mean adult height increased in the twentieth century across the world, some countries experiencing an increase of 20 cm during this period [13]. This trend has been related to the improvement of the standard of living in industrialised and post-industrialised societies [3, 18, 19], with expected differentials between regions [13] and within countries [14, 15]. Aside from providing information linked with social progress, exploring the secular trend of adult height can provide evidence about social inequalities.
Guatemala has the lowest mean height for adult women in the world [13]. Model-based estimates of adult height in the twentieth century identified the mean height of Guatemalan women born in 1896 which was 140.3 cm, with a 9 cm increase over one hundred years [13]. Scholars focusing on the anthropometric history of Latin America in the second half of the twentieth century found that Guatemala was one of the countries with the lowest height increase in the region [20]. Similar to findings in other countries, adult height in Guatemala has been associated with socio-economic status [15]. Scholars have found that the height gap between women at the lowest and the highest socio-economic group in Guatemala is one of the widest out of 54 low- and middle-income countries (LMICs) [15].
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Guatemala has been historically characterised by high levels of socio-economic inequalities, being one of the countries with the lowest public expenditure for social development programmes in Latin America [21]. The proportion of the population living in relative poverty has remained similar over recent decades, with 59.3% of the population classified as being below the poverty line, while 23.4% are under extreme poverty in 2014 [22]. Guatemala is an ethnically diverse country, ranking second with the highest proportion of indigenous population in the region [23]. Greater socio-economic disadvantages have been observed among indigenous populations, with 79.2% of its population classified as below the poverty line [22]. Other ethnic differences have been observed in relationship with social capital and labour opportunities [21, 24].
Poverty and poor standards of living in Guatemala have been associated with child growth deficit [25, 26]. Results from the latest Demographic and Health Surveys in 2014-2015, estimates that 46.5% of children were stunted [27], positioning Guatemala among the top ten countries for child stunting in the world [28]. Child stunting in Guatemala has been associated with different factors including ethnic background, children born to an indigenous mother more likely to have a low height-for-age compared to non-indigenous children [25; 29,30,31,32]. Considering the high prevalence of child stunting, the ethnic divide and being the shortest female adult population in the world, it becomes relevant to explore differences in adult height between indigenous and non-indigenous women in Guatemala.
We hypothesise that there will be a difference in height between indigenous and non-indigenous population groups mediated by socio-economic factors measured at individual and household level, as well as environmental-level factors. Previous research conducted in Guatemala has shown economic and social inequalities related to human growth at early age, and we explore how these factors are related to height among Guatemalan women. The aim of this research is to identify differences in the mean adult height for indigenous and non-indigenous women over a 50 years period, women born between 1945 and 1995, a period characterised by political turmoil ending in 1996 with the peace agreements [33] and the implementation of Neo-liberal economic policies [34].
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