Worldwide Timing of Growth Faltering: Revisiting Implications for Interventions

Universidade Federal de Pelotas, Postgraduate Program in Epidemiology, Rua Marechal Deodoro 1160, 96020-220, Pelotas, RS, Brazil.
PEDIATRICS (Impact Factor: 5.47). 02/2010; 125(3):e473-80. DOI: 10.1542/peds.2009-1519
Source: PubMed


Our goal was to describe worldwide growth-faltering patterns by using the new World Health Organization (WHO) standards.
We analyzed information available from the WHO Global Database on Child Growth and Malnutrition, comprising data from national anthropometric surveys from 54 countries. Anthropometric data comprise weight-for-age, length/height-for-age, and weight-for-length/height z scores. The WHO regions were used to aggregate countries: Europe and Central Asia; Latin America and the Caribbean; North Africa and Middle East; South Asia; and sub-Saharan Africa.
Sample sizes ranged from 1000 to 47 000 children. Weight for length/height starts slightly above the standard in children aged 1 to 2 months and falters slightly until 9 months of age, picking up after that age and remaining close to the standard thereafter. Weight for age starts close to the standard and falters moderately until reaching approximately -1 z at 24 months and remaining reasonably stable after that. Length/height for age also starts close to the standard and falters dramatically until 24 months, showing noticeable bumps just after 24, 36, and 48 months but otherwise increasing slightly after 24 months.
Comparison of child growth patterns in 54 countries with WHO standards shows that growth faltering in early childhood is even more pronounced than suggested by previous analyses based on the National Center for Health Statistics reference. These findings confirm the need to scale up interventions during the window of opportunity defined by pregnancy and the first 2 years of life, including prevention of low birth weight and appropriate infant feeding practices.

    • "This stunting is associated with greater risk of death from infectious diseases in childhood (Caulfield et al. 2004; Pelletier et al. 1995), poorer cognition, (Grantham-McGregor et al. 2007; Walker et al. 2011) poorer educational outcomes (Alderman et al. 2006; Maluccio et al. 2009) and lower adult earnings (Hoddinott et al. 2013). For these compelling reasons, normalizing child growth during the window of opportunity – between conception and the first two years of postnatal life (Victora et al. 2010) – represents an important long-term investment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In 2011, one in every four (26%) children under 5 years of age worldwide was stunted. The realization that most stunting cannot be explained by poor diet or by diarrhoea, nor completely reversed by optimized diet and reduced diarrhoea has led to the hypothesis that a primary underlying cause of stunting is subclinical gut disease. Essentially, ingested microbes set in motion two overlapping and interacting pathways that result in linear growth impairment. Firstly, partial villous atrophy results in a reduced absorptive surface area and loss of digestive enzymes. This in turn results in maldigestion and malabsorption of much needed nutrients. Secondly, microbes and their products make the gut leaky, allowing luminal contents to translocate into systemic circulation. This creates a condition of chronic immune activation, which (i) diverts nutrient resources towards the metabolically expensive business of infection fighting rather than growth; (ii) suppresses the growth hormone-IGF axis and inhibits bone growth, leading to growth impairment; and (iii) causes further damage to the intestinal mucosa thereby exacerbating the problem. As such, the unhygienic environments in which infants and young children live and grow must contribute to, if not be the overriding cause of, this environmental enteric dysfunction. We suggest that a package of baby-WASH interventions (sanitation and water improvement, handwashing with soap, ensuring a clean play and infant feeding environment and food hygiene) that interrupt specific pathways through which feco-oral transmission occurs in the first two years of a child's life may be central to global stunting reduction efforts.
    Maternal and Child Nutrition 11/2015; DOI:10.1111/mcn.12220 · 3.06 Impact Factor
  • Source
    • "There is strong evidence that breast milk is the best source of nourishment for optimal infant growth and development (Kramer and Kakuma, 2012). The right nutrition in the thousand days from conception to 24 months is critical and can have both short and long-term consequences on health (Victora et al., 2010). "
    [Show description] [Hide description]
    DESCRIPTION: K2P Briefing Note on Protecting Breastfeeding in Lebanon
  • Source
    • "Currently, 195 million under-five children are affected by malnutrition; 90% of them live in sub-Saharan Africa and South Asia [5]. The nutritional status of the people of Bangladesh is considered to be worse among Asian countries, and Bangladesh ranks 57 th in relation to children aged less than 5 years, and the prevalence of childhood malnutrition in Bangladesh is one of the highest in the world; about 43% of under-5 year children are stunted, 41% have underweight and about 17% suffer from wasting [6].Therefore, the present nutritional status of the population in Bangladesh can easily "

    01/2015; 4(3):264. DOI:10.11648/j.ijnfs.20150403.13
Show more