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

ABSTRACT 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.

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Available from: Roger Shrimpton, Dec 09, 2014
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    • "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). "
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    • "The median duration of breast-feeding was 24 mo, but no correlation was found between duration of breast-feeding and the child's current height for age. However, our finding that the prevalence of stunting increased with age, being 49% in the 48-to 59-mo-old category, is in contrast with national [11] [12] and international trends [38]. This suggests that, although the first 1000 d are considered critical to development [1], inadequate intake beyond the first 2 y can further exacerbate growth impairment, or at least prevent catch-up growth. "
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    ABSTRACT: This cross-sectional study examined the nutritional factors associated with the high levels of stunting in 2- to 5-y-old children in an impoverished South African setting where liver is frequently eaten and vitamin A deficiency known to be absent. Children's dietary intake was assessed by a single 24-h recall. Heights and weights were measured and information was obtained on breast-feeding history, the child's habitual milk intake, as well as substance use by the mother during pregnancy (n = 150). The overall prevalence of stunting was 36.9% (CI 29.2, 44.6) and increased with age, being 49% in the 4- to 5-y-old age category. Birth weight correlated significantly with height-for-age z-scores (HAZ; r = 0.250, P = 0.003), and was lower in children whose mothers smoked and used alcohol during pregnancy than in children whose mothers abstained (P < 0.0001). Median intake of energy, carbohydrate and protein was adequate. Median intake for all micronutrients was at least 90% of the estimated average requirement, except for calcium, vitamin D and vitamin E, which was 21%, 15%, and 32%, respectively. Intake of fat, calcium, phosphorous, vitamin D, riboflavin, and vitamin B12 (nutrients that typically occur in milk) was significantly lower in stunted than in non-stunted children (P < 0.05). When excluding children with low birth weight, intake of calcium, vitamin D, and riboflavin were still significantly lower (P < 0.05). HAZ was higher in children who habitually drank milk compared to those who did not (P = 0.003). Inadequate calcium and vitamin D intake, presumably because of low intake of milk after weaning, may have contributed to stunting in this population. Copyright © 2015 Elsevier Inc. All rights reserved.
    Nutrition 12/2014; 31(6). DOI:10.1016/j.nut.2014.12.011 · 2.93 Impact Factor
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    • "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 "
    5th Regional Public Health Conference, Jointly organized by Bangladesh University of Health Science and Department of International Health, University of Oslo, Norway.; 12/2014
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