Effect of Pre-Pubertal Body Mass Index Status on Longitudinal Height Trajectory in Vietnamese Children: 2018-2025 School Health Analysis

Background

Vietnam and similar low-middle-income countries face a double/triple burden of overweight-obesity, thinness, and stunting. We examined how pre-pubertal BMI affects longitudinal height trajectories in a large Vietnamese cohort.

Methods

We analyzed annual school health data from Hanoi, Ho Chi Minh City, and Haiphong (2018–2025). Children with ≥3 visits (n = 40,887) were classified by WHO BMI category (thinness, normal, overweight, obesity) at sex-specific pre-pubertal index ages (males 11 years, females 9 years). Height trajectories were visualized via LOESS smoothing. Between-group differences were tested using Kruskal-Wallis with Dunn post-hoc tests and bootstrap median differences. BMI transitions assessed whether weight-status normalization recovered height potential.

Results

At index ages, obese children were taller than normal-BMI peers (+5.1 cm at 11 years, peaking at +5.8 cm at 12 years for males and +4.0 cm at 9 years for females), while thin children were shorter (−3.0 to -4.2 cm). Differences narrowed progressively, becoming non-significant by 15 years in females (p = 0.885) and 17 years in males (p = 0.201). BMI normalization was associated with convergence toward normal-weight peers while persistent thinness showed no recovery. Results were consistent across ages, cities, and sensitivity analyses.

Conclusions

Pre-pubertal BMI shapes the tempo, not outcome, of pubertal height gain, supporting early, sex-specific nutritional intervention without compromising adult height.

Key messages

• Pre-pubertal BMI shapes the tempo, not the final outcome, of pubertal height gain. Obese children are taller in childhood but this advantage resolves by mid-to-late adolescence, while thinness causes lasting shortfall unless BMI normalizes during puberty.

• This is the first large longitudinal Southeast Asian cohort to link BMI-transition patterns (not just cross-sectional BMI) to height recovery, filling a gap dominated by Western and East Asian studies.

• The study supports earlier, sex-specific nutritional intervention (before 11 years old for boys and 9 years old for girls) without compromising adult height.