Worldwide Timing of Growth Faltering: Implications for Nutritional Interventions

UNICEF, New York, New York, United States
PEDIATRICS (Impact Factor: 5.47). 06/2001; 107(5):E75. DOI: 10.1542/peds.107.5.e75
Source: PubMed


It is widely assumed that growth faltering starts at around 3 months of age, but there has been no systematic assessment of its timing using representative national datasets from a variety of countries.
The World Health Organization Global Database on Child Growth and Malnutrition includes the results of 39 nationally representative datasets from recent surveys in developing countries. Based on these data, mean z scores of weight for age, length/height for age, and weight for length/height were compared with the National Center for Health Statistics and Cambridge growth references, for children younger than 60 months.
Mean weights start to falter at about 3 months of age and decline rapidly until about 12 months, with a markedly slower decline until about 18 to 19 months and a catch-up pattern after that. Growth faltering in weight for length/height is restricted to the first 15 months of life, followed by rapid improvement. For length/height for age, the global mean is surprisingly close to National Center for Health Statistics and Cambridge references at birth, but faltering starts immediately afterward, lasting well into the third year.
These findings highlight the need for prenatal and early life interventions to prevent growth failure.

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Available from: Roger Shrimpton, Dec 03, 2015
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    • "Substantial weight loss usually reflects disease or lack of food. Previous studies indicate that a child's growth and development falters from normal growth rates most acutely during the child's first two years of life (Martorell et al., 1994; Shrimpton et al., 2001). Specifically, stunting is strongly determined from conditions in the period between birth and the child's second birthday. "
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    • "To that end we took three steps. First, we adopted a very flexible specification of the time-invariant determinants including monthly dummy variables to capture the progressive 752 WORLD DEVELOPMENT growth faltering process that malnourished populations undergo until around two years of age (Shrimpton et al., 2001; Victora, de Onis, Curi Hallal, Blö ssner, & Shrimpton, 2009). Second, we undertook non-parametric graphical analyses of all time-varying continuous variables to examine whether there exists non-linearities in their relationships with HAZ scores. "
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    • "Most growth faltering occurs between the ages of six and 24 months when a child is no longer protected by exclusive breastfeeding and is more exposed to disease and infection through contaminated food or water. Some evidence suggests that a child adequately nourished after 24 months of age is unlikely to recover growth 'lost' in the first two years as a result of malnutrition (Shrimpton et al., 2001; Victora et al., 2010). Adolescence is a period of rapid growth during which many important physical, intellectual, and psychological events take place. "
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