Front. Pediatr. Frontiers in Pediatrics Front. Pediatr. 2296-2360 Frontiers Media S.A. 10.3389/fped.2025.1634605 Systematic Review Prevalence of growth retardation among children and adolescents in China: a systematic review and meta-analysis WangWei 1 2 †Writing – original draft QiuZhanpeng 1 2 †Writing – original draft WangFang 3Writing – review & editing QiuDongsheng 1 4Writing – review & editing YeGuoping 1 4 *Writing – review & editingSupervisionConceptualization Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Xiamen, China Fujian University of Traditional Chinese Medicine, Fujian, Fuzhou, China Waigang Town Community Health Service Center, Jiading District, Shanghai, China Xiamen Hospital, Dongzhimen Hospital, Beijing University of Chinese Medicine, Fujian, Xiamen, China Correspondence: Guoping Ye 1661437472@qq.com

These authors have contributed equally to this work

 17122025 2025 131634605 24052025 20112025 24112025 © 2025 Wang, Qiu, Wang, Qiu and Ye. 2025Wang, Qiu, Wang, Qiu and Yehttps://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Objective

The objective of this study was to determine the prevalence of growth delay in Chinese children and adolescents through a meta-analysis, providing scientific evidence for early intervention and prevention.

Methods

Relevant studies on the prevalence of growth delay in Chinese children were retrieved from eight major databases: China National Knowledge Infrastructure (CNKI), Wanfang, Chongqing VIP, Chinese Biomedical Literature Database, PubMed, Embase, Cochrane Library, and Web of Science. Two researchers independently assessed the quality of the studies based on the inclusion criteria for cross-sectional studies outlined in the STROBE guidelines. Any discrepancies were resolved through cross-checking. Data extracted from studies were analyzed using Stata 15.

Results

A total of 50 studies were included, with a sample size of 2,644,818 participants. The meta-analysis revealed that the overall prevalence of growth delay in Chinese children and adolescents was 5.7% (95% CI: 5.3%–6.2%). Subgroup analysis by age demonstrated the following prevalence rates: 7.4% (95% CI: 6.6%–8.3%) for ages 0–2 years, 6.8% (95% CI: 6.1%–7.4%) for ages 3–6 years, 3.9% (95% CI: 3.6%–4.2%) for ages 6–12 years, and 3.0% (95% CI: 2.3%–3.6%) for ages 13–18 years. Statistically significant differences were observed between age groups (P < 0.05). With regard to gender, the prevalence was 6.2% (95% CI: 5.4%–7.0%) for males and 6.6% (95% CI: 5.7%–7.5%) for females, with no significant difference between genders (P > 0.05). Analysis by residential area indicated that the prevalence in rural areas was 8.4% (95% CI: 6.2%–10.5%), compared to 3.5% (95% CI: 2.5%–4.4%) in urban areas, showing a statistically significant difference (P < 0.05). Geographically, the Southwest region had the highest prevalence at 9.2% (95% CI: 4.4%–14%), followed by South China (7.0%, 95% CI: 5.7%–8.3%), Northwest China (5.7%, 95% CI: 2.5%–9.0%), Central China (3.8%, 95% CI: 1.4%–6.1%), East China (2.6%, 95% CI: 2.0%–3.2%), and North China (1.8%, 95% CI: 1.1%–2.4%). No significant differences were found in growth delay prevalence among regions (P > 0.05). In terms of study year, the prevalence was 25.8% (95% CI: 2.2%–49.5%) in 2005–2009, 5.2% (95% CI: 3.9%–6.6%) in 2010–2019, and 3.0% (95% CI: 2.7%–3.3%) in 2020–2024, with statistically significant differences observed across years (P < 0.05).

Conclusion

The prevalence of growth delay in Chinese children and adolescents is gradually decreasing, with variations across age groups and residential environments. Efforts to alleviate this issue should include enhanced public health awareness, promotion of healthy lifestyles, improved family nutrition education and training, and strengthening of the healthcare system.

Systematic Review Registration

CRD42024579022.

 growth delay stunting children adolescents prevalence meta-analysis The author(s) declare financial support was received for the research and/or publication of this article. This study was supported by the Natural Science Foundation of Fujian Province (No. 2025J011449), the Jinglu Talent Program for Traditional Chinese Medicine of Beijing University of Chinese Medicine Dongzhimen Hospital Xiamen Hospital (No. Xia Zhong Yi [2024] 160), and the Xiamen Natural Science Foundation Joint Program (No. 3502Z20227362). section-at-acceptancePediatric Endocrinology Introduction

The physical development of children is not only an important indicator of their nutritional and health status but also serves as a key marker for the socioeconomic development of a country or region (1, 2). With ongoing socioeconomic development, the nutritional status of children has significantly improved. However, the issue of growth retardation among children in developing countries remains a public health concern that warrants attention (3). According to a 2020 survey by the World Health Organization (WHO) (4), 149 million children globally are affected by growth delays, with a prevalence rate of 22%. The 2020 survey on the nutritional status of Chinese residents (5) revealed that the prevalence of growth retardation was 4.8% among children under 6 years of age and 2.2% among those aged 6–17 years. In rural areas, the prevalence of growth retardation among children and adolescents is approximately 2–3 times higher than that in urban areas. The causes of growth retardation in children are complex and diverse, often closely related to genetics, endocrine factors, and insufficient nutritional intake (6). Growth retardation directly impacts the physical and mental health of children and adolescents, increasing the risk of chronic diseases such as obesity, cardiovascular disease, and diabetes in adulthood. It also has long-term negative effects on cognitive and socioemotional development and may even lead to depression. In severe cases, it may lead to developmental disorders affecting various organs and tissues, as well as deficiencies in immune and neurological function (7, 8). With recent advancements in diagnostic and therapeutic technologies, together with ongoing economic development, the incidence of growth retardation in Chinese children has demonstrated a downward trend. Furthermore, at the international level, childhood nutritional intervention is considered one of the most valuable investments in human capital (9). In China, national-level censuses are conducted intermittently, while localized and regional studies are conducted annually. These studies ensure that incidence data remain temporally relevant, underscoring the importance of regularly incorporating new evidence to update the prevalence of growth retardation among Chinese children. Such efforts enable a timely and comprehensive understanding of the overall status, trends, and influencing factors related to physical development in this population. Accordingly, this study employs a meta-analytic approach to update the current epidemiological profile of growth retardation in Chinese children and investigate its potential influencing factors in depth, thereby providing an evidence base for the development of more targeted intervention strategies.

 Materials and methods

This report adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (10), and the study protocol was registered and published on PROSPERO [CRD42024579022].

Literature search

A literature search was conducted on the prevalence of growth retardation and stunting in Chinese children in both Chinese and English databases. The Chinese databases included China National Knowledge Infrastructure (CNKI), Wanfang, Chongqing VIP, and China Biology Medicine disc (CBMdisc). The English databases included PubMed, Embase, Cochrane Library, and Web of Science. The search covered the period from the inception of each database to 20 September 2024, without language restrictions but limited to studies conducted in China. In addition, references from systematic reviews and gray literature were also screened to avoid missing relevant studies. The following Chinese search terms were included: “儿童,” “青少年,” “生长迟缓,” “矮小,” “患病率,” “流行率,” “流行病学调查.” For the English search, both subject terms and free terms were used, including “Adolescent,” “Child,” “Growth Disorders,” “Stunting,” “epidemiology,” “Prevalence,” “China,” and “Chinese.” The search strategies were adjusted according to the characteristics of each database, and cross-database searches were conducted to ensure comprehensiveness. For example, the search strategy for PubMed is presented in Table 1, additional search strategies available in Supplementary 1.

PubMed search strategies for growth retardation prevalence in Chinese children and adolescents.

Steps Retrieval formula
#1 “Adolescent” [Mesh] OR “Adolescents” [Title/Abstract] OR “Adolescence” [Title/Abstract] OR “Female Adolescent” [Title/Abstract] OR “Male Adolescent” [Title/Abstract] OR “Youth” [Title/Abstract] OR “Teen” [Title/Abstract] OR “Teenager” [Title/Abstract] OR “Child” [Mesh] OR “children” [Title/Abstract]
#2 Growth Disorders[Mesh] OR “Stunted Growth” [Title/Abstract] OR “Growth, Stunted” [Title/Abstract] OR “Growth Disorder” [Title/Abstract] OR “Stunting” [Title/Abstract] OR “Stuntings” [Title/Abstract]
#3 “China” [Mesh] OR “chinese” [Title/Abstract]
#4 “Prevalence” [Mesh] OR “Prevalences” [Title/Abstract] OR “Point Prevalence” [Title/Abstract] OR “Period Prevalence” [Title/Abstract] OR “Period Prevalences” [Title/Abstract] OR “epidemiology” [Subheading] OR “epidemics” [Title/Abstract] OR “incidence” [Title/Abstract] OR “morbidity” [Title/Abstract] OR “occurrence” [Title/Abstract]
#5 #1 AND #2 AND #3 AND #4
Inclusion and exclusion criteria

The inclusion criteria were as follows: (1) studies conducted in China with participants aged ≤18 years; (2) observational or cross-sectional studies with clear sample size and reported prevalence or number of cases; (3) clearly defined diagnostic criteria and methods; and (4) sample size ≥5,000 participants.

The exclusion criteria were as follows: (1) studies with incomplete data or duplicated publications; (2) studies with inadequate design or statistical errors; and (3) reviews, conference abstracts, and similar publications.

 Literature screening and data extraction

The identified studies were first input into EndNote 20 software for automatic screening and removal of duplicates. Two independent researchers (WW and FW) then screened the deduplicated articles. The titles and abstracts of the articles were initially reviewed, followed by downloading and full-text review of the studies that met the inclusion criteria after initial screening. During this process, all excluded articles were recorded, with rational explanations provided for exclusion. Any disagreements during this process were resolved through discussion or adjudicated by a third senior researcher. The final screening results were cross-checked by two researchers.

The following information or data were extracted from the included studies: (1) study characteristics: first author, publication year, geographical location (province), region (urban/rural), sample size, and diagnostic criteria; (2) participant characteristics: age, gender, and origin; and (3) outcome measures: prevalence (by gender, region, and age). If any information required for extraction was missing or not clearly reported in the studies included in the systematic review, the researchers attempted to contact the authors to obtain the data or directly retrieved the original studies for supplementation. Any disagreements that arose during the process of data extraction were resolved through discussion or adjudicated by a third senior researcher.

 Literature quality assessment

The quality of the included studies was assessed using the STROBE checklist (11) for cross-sectional studies, which consists of 22 items covering the Introduction, Methods, Results, and Discussion sections. Each item that met the criteria was assigned 1 point, and those that did not were assigned 0 points, with a total score of 22 points. A score of ≤5 was considered low quality, a score of 6–11 was considered moderate quality, and a score >11 was considered high quality.

 Results Basic characteristics of included studies

A total of 3,139 articles were initially retrieved. After screening the titles and abstracts and conducting a full-text review, 50 studies (12–61) were included in the final analysis. Of these, 45 were in Chinese (12–14, 16–22, 24–40, 42–48, 50–53, 55–61) and five were in English (15, 23, 41, 49, 54). The literature screening process and results are shown in Figure 1. The studies covered data from 31 provinces and four direct-controlled municipalities across China. The total sample size across all studies was 2,644,818 participants, among whom 77,586 cases of growth retardation were identified.

Flowchart of identification and screening for studies on growth retardation prevalence in Chinese children and adolescents.

Flowchart outlining the process of identifying studies via databases and registers. Initially, 3139 articles were identified, with duplicates (1985) removed, leaving 1154 for title and abstract screening. After exclusions for irrelevance (628), mismatched study types (315), non-Chinese studies (8), and substandard sample sizes (118), 85 documents were read fully. Further exclusions for incomplete text (8), data duplication (3), and intervention incompatibility (24) resulted in 50 studies included in the final literature. Quality assessment of included studies

Two studies (24, 26) scored 5 points and were classified as low quality. Thirty-nine studies (12–22, 25, 27–31, 33–36, 38–40, 42, 44–48, 50, 52, 53, 55–58, 60, 61) scored between 6 and 11 points and were classified as moderate quality. Nine studies (23, 32, 37, 41, 43, 49, 51, 54, 59) scored above 11 points, with the highest score being 15. The average score across the studies was 8.4 points (Table 2).

General information and quality scores of the included studies.

Author Year Investigation period Area Regions Diagnostic criteria Sampling methods Age (Year) Case Overall Boys (case/overall) Girls (case/overall) Urban (case/overall) Rural (case/overall) STROBE Scores
Chen 2005 2000–2004 Jinjiang South China 4 Random 0–7 9,503 20,493 — — — — 7
Dang 2005 2000–2004 40 counties in Tibet Southwest Region 2 Stratified random 0–3 1,668 7,252 1,004/4,112 664/3,140 — — 8
Cheng 2009 2003 Shanghai East China 2 Cluster sampling 6–18 2,658 70,431 1,172/34,449 1,486/35,982 836/30,121 1,822/40,310 10
Wang 2009 2006 13 provinces in the Midwest - 2 Stratified random 0–5 2,428 8,041 1,437/4,463 991/3,578 — — 10
Zhang 2011 2011 Meizhou South China 2 Cluster sampling 0–5 195 12,928 108/6,769 87/6,159 — — 6
Liu 2013 2013 Ningbo East China 4 Stratified cluster random 0–7 581 8,006 333/4,139 248/3,867 104/2,506 477/5,500 11
Wang 2013 2012 Sichuan Southwest Region 2 Random cluster 0–5 5,634 64,038 2,894/33,422 2,740/30,616 — — 8
Xiang 2014 2010–2011 Chongqing Southwest Region 3 Cluster 6–18 16,644 70,952 5,671/36,427 10,973/34,525 7,164/42,789 9,480/28,163 8
Wu 2015 2011 Beijing North China 2 Random cluster 6–19 2,630 99,482 1,425/50,889 1,205/48,593 — — 12
Li 2015 2013 Yan'an Northwest China 2 Cluster 7–13 770 8,043 339/4,043 431/4,000 370/4,652 400/3,391 6
Chen 2016 2014 Dongguan South China 2 Cluster 3–6 748 18,484 — — — — 6
Jing 2016 2012–2014 Chongqing Southwest Region 2 Cluster 3–6 164 17,329 76/8,798 88/8,531 — — 7
Chen 2017 2014 Anhui East China 5 Stratified cluster 7–12 172 6,082 85/3,104 87/2,978 68/3,049 104/3,033 6
Liu 2017 2017 Jining East China 3 Random cluster 6–16 287 9,095 166/4,937 121/4,158 120/4,448 167/4,647 5
Tao 2017 2017 Yizheng East China 2 Cluster 6–14 210 9,338 — — 84/6,493 126/2,845 8
Yu 2017 2015 Wuhu East China 2 Cluster 3–6 449 89,060 — — 176/43,649 273/45,411 6
Qin 2017 2016 Wuhan Central China 6 Random 3–14 1,640 30,000 789/15,724 851/14,276 682/16,992 958/13,008 10
Xu 2017 2017 Jingdezhen Central China 2 Cluster 6–12 194 10,436 91/5,267 103/5,169 118/6,733 76/3,703 5
Fang 2018 2010–2012 31 inland provinces - 1 Cluster random 6–17 1,154 36,058 654/18,204 500/17,854 — — 7
Sang 2018 2018 Datong North China 5 Random cluster 7–18 272 14,179 128/6,858 144/7,321 — — 12
Wang 2018 2015 Taicang East China 2 Cluster 3–14 1,174 63,049 640/34,171 534/28,878 185/20,192 989/42,857 11
Shi 2019 2017–2019 Shaanxi Northwest China 5 Cluster 3–6 279 8,719 118/4,358 161/4,361 — — 6
Zhu 2019 2018 Yunnan Southwest Region 2 Stratified cluster 0–5 139 5,394 — — 87/2,358 52/3,036 8
Zhang 2020 2016 9 cities in China - 3 Stratified cluster sampling <7 2,141 110,499 1,121/57,921 1,020/52,578 904/55,524 1,237/54,975 13
Zhang 2020 2017 Southern Tianjin North China 3 Cohort study 3.5–6.5 75 6,757 40/3,624 35/3,133 — — 6
Hong 2020 2018 Suzhou East China 5 Cluster sampling method 6–12 2,385 82,508 1,168/44,779 1,217/37,729 731/39,745 1,654/42,763 12
Lin 2020 2019 Xiamen South China 2 Random cluster 1–6 391 43,586 — — — — 6
Xiong 2020 2018 Rong'an South China 4 Random cluster sampling 6–12 700 8,729 395/4,452 305/4,277 — — 7
Guo 2020 2018–2019 Baota District, Yan'an Northwest China 2 Cluster sampling 7–12 525 7,300 245/3,906 280/3,394 — — 7
Gou 2020 2016–2018 Chengdu Southwest Region 2 Cluster 1–7 1,115 99,190 645/51,583 470/47,607 — — 6
Liu 2021 2021 7 provinces in China - 2 Random cluster sampling <2 675 17,193 446/8,927 229/8,266 — — 12
Zhu 2021 2018 5 cities in Shanxi North China 2 Stratified cluster random sampling <5 87 6,407 41/3,227 46/3,180 — — 8
Zhao 2021 2018–2020 Jiading East China 4 Cluster 0–3 11 8,262 — — — — 6
Huang 2021 2020 Pingshan South China 5 Whole random 6–14 538 12,504 286/6,906 252/5,598 — — 7
Yin 2021 2020 Foshan South China 2 Whole 3–6 39 32,165 — — — — 6
Wang 2021 2019 Xinjiang Production Northwest China 2 Cluster <7 585 9,051 — — — — 6
Zheng 2021 2014–2018 Lanzhou Northwest China 2 Whole 0–5 4,602 671,394 — — — — 6
Luo 2021 2019 Sichuan Southwest Region 2 Whole random <5 384 7,534 229/3,901 155/3,633 71/3,025 313/4,509 14
Yu 2022 2020.03 Weifang East China 4 Cluster sampling 4–15 166 8,740 74/4,675 92/4,065 — — 7
Zhang 2,022 2018–2021 Suzhou East China 2 Cluster 1–5 3,183 319,791 1,071/154,253 2,112/165,538 — — 8
Wang 2022 2020–2022 Hainan South China 2 Stratified random sampling 0–5 256 8,244 145/4,282 111/3,962 50/2,266 206/5,978 15
Liu 2022 2017–2019 10 cities in Henan Province Central China 5 Cluster sampling 3–18 662 12,667 361/6,569 301/6,098 — — 9
Li 2,022 2019.08–11 Rural Hunan Central China 2 Stratified cluster sampling <6 241 5,529 104/2,806 137/2723 — — 13
Zhang 2022 2019–2020 Hanzhong Northwest China 5 Whole 3–12 857 11,690 431/6,153 426/5,537 412/6,915 445/4,775 13
Shi 2023 2021 Dongying East China 2 Whole 6–12 1,541 85,376 769/44,850 772/40,526 851/45,734 690/39,642 7
Wu 2023 2018–2020 Xuzhou East China 2 Cluster 2–6 350 6,820 170/3,593 180/3,227 — — 6
Pan (1) 2023 2018–2022 Shaoguan South China 2 Cluster 0–3 656 17,542 — — — — 9
Pan (2) 2023 2020–2022 Shaoguan South China 2 Whole sampling 3–6 861 18,139 465/9,614 396/8,525 — — 9
Zhang 2023 2019–2020 Panyu South China 2 Whole 0–6 4,928 432,085 — — — — 11
Zhu 2023 2019–2021 Zhengzhou Central China 2 Random cluster 3–6 39 6,938 18/3,562 21/3,376 — — 8

Diagnostic Criteria: 1, height below the age-specific mean by 1 SD; 2, height below the age-specific mean by 2 SD; 3, growth delay: height below the age-specific mean by 2 SD; Short stature: Height below the age-specific mean by 3 SD; 4, mild: height below the age-specific mean by 1 SD; moderate: <2 SD; Severe: <3 SD; 5, height below the age-specific mean by 3 SD; 6, combined results from imaging, blood tests, and height measurements.

 Meta-analysis Prevalence of growth retardation

A total of 50 studies were included in this analysis, all of which reported the prevalence of growth retardation. The total sample size across the studies was 2,644,818 children and adolescents aged 0–18 years, with 77,586 cases of growth retardation identified. Heterogeneity testing across the 50 studies revealed an I2 of 99.9% (P < 0.05), indicating high heterogeneity. A random-effects model was applied for the meta-analysis, which showed that the overall prevalence of growth retardation among children and adolescents was 6.0% (95% CI: 5.0%–6.0%) (Figure 2).

Forest plot of meta-analysis of the total prevalence of growth retardation in Chinese.

Forest plot displaying effect sizes and confidence intervals for various studies. Dots represent effect estimates with horizontal lines showing 95% confidence intervals. The summary effect is indicated at the bottom, showing high heterogeneity (I² = 99.9%). A vertical reference line is at zero, with effect sizes mostly positive, emphasizing the summary effect and individual study impacts. Subgroup analysis

Owing to considerable heterogeneity among studies, subgroup analysis was performed based on gender, age, residential environment (urban/rural), region, and year of publication. After testing, it was found that heterogeneity remained significant; therefore, a random-effects model was used for pooled analysis (Tables 3, 4).

A total of 35 studies involving children and adolescents of different ages were included in the analysis of growth retardation. The highest prevalence was observed in infants aged 1 year, at 8.9% (95% CI: 7.3%–10.5%), while the lowest prevalence was found in adolescents aged 15 and 16 years, at 1.9% (95% CI: 1.0%–2.9%) and 1.9% (95% CI: 1.1%–2.7%), respectively. The differences in growth retardation prevalence across different age groups were statistically significant (P < 0.05) (Table 3).

Subgroup analysis of growth retardation prevalence: results by age.

Age No. of articles No. of participants No. of cases Prevalence (95% CI) I2% P-value
0– 11 80,374 3,098 4.6% (3.5%–5.8%) 98.7
1– 15 93,393 4,510 8.9% (7.3%–10.5%) 99.7
2– 15 75,438 3,661 8.7% (7.1%–10.3%) 99.7
3– 18 87,500 3,897 8.0% (6.5%–9.4%) 99.6
4– 18 115,613 4,509 7.8% (6.4%–9.3%) 99.6
5– 12 118,799 3,516 6.9% (5.4%–8.3%) 93.4
6– 18 73,822 2,900 6.4% (5.0%–7.9%) 96.3
7– 15 46,669 1,327 3.4% (2.8%–4.0%) 99.8
8– 16 46,802 1,388 3.7% (3.0%–4.5%) 99.9
9– 16 47,083 1,430 3.8% (3.0%–4.6%) 96.9
10– 15 44,720 1,414 3.9% (3.1%–4.7%) 96.5
11– 15 36,082 1,284 4.4% (3.3%–5.4%) 97.5
12– 14 29,763 1,105 4.6% (3.5%–5.7%) 96.7
13– 7 21,990 861 3.5% (1.9%–5.0%) 97.8
14– 7 17,687 589 3.5% (2.4%–4.6%) 92.2
15– 5 13,318 270 1.9% (1.0%–2.9%) 90.2
16– 3 7,902 147 1.9% (1.1%–2.7%) 77.4
17– 3 7,061 142 2.8% (1%–5.7%) 97.6
18– 1 2,373 58 2.4% (1.8%–3.1%) 0.0
Overall 35 966,389 36,106 5.4% (5.1%–5.8%) 98.8 <0.01

Subgroup analysis of growth retardation prevalence: results by age group.

Age No. of articles No. of participants No. of cases Prevalence (95% CI) I2% P-value
0–2 16 249,205 11,269 7.4% (6.6%–8.3%) 99.6
3–6 28 395,734 14,822 6.8% (6.1%–7.4%) 99.6
7–12 21 251,119 7,948 3.9% (3.6%–4.2%) 99.7
13–18 7 70,331 2,067 3.0% (2.3%–3.6%) 96.4
Overall 35 966,389 36,106 5.4% (5.1%–5.8%) 98.8 <0.01

Subgroup analysis based on the age groups 0–2, 3–6, 7–12, and 13–18 years showed that the prevalence of growth retardation differed significantly across these age groups (P < 0.05) (Table 4).

A total of 38 studies on growth retardation in adolescents of different genders were included. The prevalence was 6.2% (95% CI: 5.4%–7.0%) in boys and 6.6% (95% CI: 5.7%–7.5%) in girls. There was no statistically significant difference in the prevalence of growth retardation between genders (P > 0.05) (Table 5).

A total of 18 studies on growth retardation in adolescents from different residential environments were included. The prevalence was higher in rural adolescents, at 8.4% (95% CI: 6.2%–10.5%), compared to 3.5% (95% CI: 2.5%–4.4%) in urban adolescents. The difference in prevalence between rural and urban environments was statistically significant (P < 0.01) (Table 5).

A total of 46 studies on growth retardation in adolescents from different regions were included. The highest prevalence was observed in the Southwest region, at 9.2% (95% CI: 4.4%–14%), followed by South China at 7.0% (95% CI: 5.7%–8.3%), the Northwest region at 5.7% (95% CI: 2.5%–9.0%), Central China at 3.8% (95% CI: 1.4%–6.1%), East China at 2.6% (95% CI: 2.0%–3.2%), and North China at 1.8% (95% CI: 1.1%–2.4%). There was no statistically significant difference in the prevalence of growth retardation between regions (P > 0.05) (Table 5).

Subgroup analysis by year of survey showed that the prevalence of growth retardation in children and adolescents was 25.8% (95% CI: 2.2%–49.5%) during 2005–2009, 5.2% (95% CI: 3.9%–6.6%) during 2010–2019, and 3% (95% CI: 2.7%–3.3%) during 2020–2024. The differences in the prevalence across different publication years were statistically significant (P < 0.01) (Table 5).

Subgroup analysis of growth retardation prevalence in Chinese children and adolescents.

Variable Sections No. of articles No. of participants No. of cases Prevalence (95% CI) I2% P-value
Gender Overall 38 1,383,675 55,325 6.4% (5.8%–7.5%) 99.8 0.86
Boys 38 709,717 25,354 6.2% (5.4%–7.0%) 99.8
Girls 38 673,958 29,971 6.6% (5.7%–7.5%) 99.9
Setting Overall 18 685,737 32,482 5.9% (4.8%–6.9%) 99.9 0.10
Urban 18 337,191 13,013 3.5% (2.5%–4.4%) 99.8
Rural 18 348,546 19,469 8.4% (6.2%–10.5%) 99.9
Region Overall 46 2,473,027 71,188 5.1% (4.6%–5.5%) 99.9 0.45
North China 4 126,825 3,064 1.8% (1.1%–2.4%) 98.6
East China 13 740,119 13,167 2.6% (2.0%–3.2%) 99.8
South China 11 604,406 18,815 7.0% (5.7%–8.3%) 100.0
Central China 5 55,134 2,776 3.8% (1.4%–6.1%) 99.7
Northwest China 6 699,435 7,618 5.7% (2.5%–9.0%) 99.8
Southwest Region 7 247,108 25,748 9.2% (4.4%–14%) 100.0
Year Overall 50 2,644,818 77,586 5.7% (5.3%–6.2%) 99.9 <0.01
2005–2009 4 78,472 16,257 25.8% (2.2%–49.5%) 100.0
2010–2019 19 509,706 33,336 5.2% (3.9%–6.6%) 99.9
2020–2024 27 2,056,640 27,993 3.0% (2.7%–3.3%) 99.8
Sensitivity analysis

The sensitivity analysis indicated that five studies had a significant impact on the pooled results. These five studies were considered the source of heterogeneity in the prevalence of growth retardation in children and adolescents (Supplementary 2).

 Publication bias

Funnel plots and Egger's test revealed the presence of publication bias in the studies on the prevalence of growth retardation in children and adolescents (P < 0.001). The Egger’s test yielded a result of t = 6.14, P = 0.017. In addition, the asymmetry of the funnel plot suggested the existence of publication bias in this body of research on the prevalence of growth retardation in children and adolescents (Supplementary 2 and Figure 3).

Funnel plot of the enrolled studies.

Funnel plot displaying effect sizes (ES) on the x-axis and standard error (Se_ES) on the y-axis. Points are scattered asymmetrically around x equals zero with pseudo 95% confidence limits shown as dashed lines. Discussion

This study aggregated 50 published research articles on childhood stunting from 2005 to 2024, covering 31 provinces and four municipalities across China, with a total sample size of 2,644,818 children and adolescents. The average AHRQ score of the included studies was 8.4, indicating medium to high quality. The meta-analysis results show that the overall prevalence of growth retardation in Chinese children and adolescents is 5.7% (95% CI: 5.3%–6.2%), which is significantly lower than the prevalence rates in underdeveloped regions like Africa [e.g., Ethiopia 36.6% (62), Rwanda 33% (63)] and Oceania (27%) (3). Previous studies (64, 65) have indicated that countries with higher rates of stunting are typically located near the equator or in the Southern Hemisphere, such as parts of Africa, the Indian subcontinent, and areas between North and South America. In contrast, socioeconomically developed regions like Europe and the U.S. have relatively lower rates of growth retardation (66, 67), largely due to high education levels, well-developed prenatal care, and adequate nutrition, which prevent adverse events during pregnancy and reduce the birth rate of stunted children (68, 69).

In this study, children and adolescents were grouped into age categories (0–2, 3–6, 7–12, 12–18) for subgroup analysis. The prevalence of growth retardation showed a fluctuating trend with age. The lowest rate was found in the 13–18 age group at 3.0%, while the highest was in the 0–2 age group at 7.4%. This could be attributed to the incomplete development of the gastrointestinal function in infants and young children (70), making them more prone to picky eating, indigestion, and bacterial or viral infections (67). Moreover, improper feeding by parents or a lack of awareness regarding height issues in this age group may have contributed to a higher prevalence of stunting. Moreover, maternal health conditions such as malnutrition, diseases during pregnancy, and prematurity are significant factors contributing to growth retardation (71–73).

Subgroup analysis also revealed that the prevalence of stunting in Chinese girls was 6.6%, slightly higher than in boys (6.2%), though the difference was not statistically significant. A study in Iran (74) also suggested no significant difference in stunting rates between boys and girls, and some Asian studies (75) found no significant gender difference either. However, some Chinese studies (18, 21) reported a higher prevalence of stunting in girls, which might be related to the increase in estrogen levels during puberty. Estrogen accelerates bone maturation, which may cause premature closure of growth plates and affect growth speed. In addition, cultural factors, such as the preference for boys over girls in some areas, may contribute to this difference by increasing attention to boys' health.

We also found that the prevalence of growth retardation was significantly higher in rural children (8.4%) compared to urban children (3.5%). This disparity may be explained by advantages in environment, resources, education, and socioeconomic conditions in urban areas (76). Families in some rural areas may face economic constraints, leading to insufficient food supply and difficulty in providing adequate high-quality proteins, vitamins, and minerals to meet children's growth needs, thereby affecting their development. In particular, children in poor regions are more likely to experience malnutrition or micronutrient deficiencies. Furthermore, rural areas often have limited healthcare access, and parents may not pay enough attention to children's health issues, causing delayed diagnosis and treatment for growth-related problems.

The study also demonstrated a significant decline in the prevalence of growth retardation over time in China, decreasing from 25.8% in 2005–2009 to 5.8% in 2010–2019, and further to 3.0% in 2020–2024. This trend is likely attributable to rapid economic development, improvements in nutrition and healthcare, public health policies, and better family education. Collectively, these factors have contributed to better living standards, increased attention to children's nutrition, and a deeper understanding of the adverse effects of growth retardation, thereby improving the overall situation.

In addition, the prevalence of stunting was highest in the Southwest region (9.2%) compared to other regions, with the order of prevalence being Southwest China (9.2%), South China (7.0%), Northwest China (5.7%), Central China (3.8%), West China (2.6%), and North China (1.8%). However, the differences were not statistically significant, likely due to variations in sample sizes and the number of included studies. China's vast geography, diverse ethnicities, economic disparities, environmental conditions, education levels, and cultural practices contribute to regional differences in stunting, necessitating further research.

 Significance and limitations

This study provides significant insights by aggregating data from 31 provinces and four municipalities across China, revealing the trends in the prevalence of growth retardation. It fills the gap of recent data on stunting rates among Chinese children. Despite being a large-sample cross-sectional study, there are some limitations: (1) There was considerable heterogeneity among studies included in this analysis. Although subgroup analysis was performed, the heterogeneity did not decrease significantly. Publication bias was detected through Egger's test and funnel plots, which may affect the accuracy of the meta-analysis results. (2) In terms of diagnostic variability, growth retardation diagnoses in the included studies often relied on measurement indicators, with no uniform laboratory diagnostic standards, which may have contributed to the heterogeneity. (3) With regard to regional representation, no research was available from Northeast China, which limits the representativeness of the analysis. In addition, the impact of ethnic factors on the prevalence of growth retardation was not considered, which may have influenced the results.

 Conclusion

In conclusion, the overall prevalence of growth retardation among Chinese children and adolescents was 5.7%, with significant differences observed across age groups, living environments, and study years. This phenomenon may be attributed to factors such as economic development, education levels, nutrition status, and healthcare conditions. Public health initiatives to promote healthy lifestyles, strengthen family nutrition education, and improve healthcare systems are therefore crucial. This study provides new guidance and data for understanding childhood stunting, offering a reference for policymaking and implementation.

 Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

 Author contributions

WW: Writing – original draft. ZQ: Writing – original draft. FW: Writing – review & editing. DQ: Writing – review & editing. GY: Writing – review & editing, Supervision, Conceptualization.

 Acknowledgments

The authors express their gratitude to all participants whose collaboration made this study possible.

 Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

 Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

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 Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fped.2025.1634605/full#supplementary-material

S1 File: Search Query.

S2 File: Research Indicators and Their Subgroup Plots.

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Edited by: Silvano Bertelloni, University of Pisa, Italy

Reviewed by: Rodolfo A. Rey, Hospital de Niños Ricardo Gutiérrez, Argentina

Arzu Uzuner, MARSEV MArmara Health Education and Research Center, Türkiye