article · Nature
Analysis of height and body-mass index records covering 71 million young people aged 5 to 19 across 200 countries from 1990 to 2020 reveals shifting global growth patterns. In 1990, urban children and adolescents were taller than rural peers in almost all nations outside a few high-income areas. Over three decades, this urban height advantage narrowed worldwide and even reversed into a slight urban disadvantage in several high-income western nations. Conversely, the urban advantage widened in much of sub-Saharan Africa, as well as parts of Oceania, South Asia, and the Middle East, where successive cohorts of rural boys failed to gain height or became shorter. Differences in body-mass index between rural and urban children remained narrow globally, generally within 1.1 kilograms per square metre. Overall, urban developmental benefits have declined globally in the twenty-first century, yet have intensified across sub-Saharan Africa.
Healthy physical development during childhood and adolescence is essential for lifelong health and well-being. By showing that rural children in sub-Saharan Africa are falling further behind their urban peers while urban advantages decline elsewhere, this evidence highlights critical disparities in child growth that can help international health bodies and public authorities recognise where nutritional and developmental interventions are most urgently needed.
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Abstract Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being 1–6 . Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m –2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
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DOI: 10.1038/s41586-023-05772-8
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