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Saavedra JM, Prentice AM. Nutrition in school-age children: a rationale for revisiting priorities. Nutr Rev 2022:6811793. [PMID: 36346900 DOI: 10.1093/nutrit/nuac089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Middle childhood and early adolescence have received disproportionately low levels of scientific attention relative to other life stages, especially as related to nutrition and health. This is partly due to the justified emphasis on the first 1000 days of life, and the idea that early deficits and consequences may not be fully reversible. In addition, these stages of life may superficially appear less "eventful" than infancy or late adolescence. Finally, there has been historical ambiguity and inconsistency in terminology, depending on whether viewing "childhood" through physiologic, social, legal, or other lenses. Nevertheless, this age bracket, which encompasses most of the primary education and basic schooling years for most individuals, is marked by significant changes, inflection points, and sexually driven divergence in somatic and brain growth and development trajectories. These constitute transformative changes, and thus middle childhood and early adolescence represents a major and last opportunity to influence long-term health and productivity. This review highlights the specificities of growth and development in school age, with a focus on middle childhood and early adolescence (5 years-15 years of age, for the purposes of this review), the role of nutrition, the short- and long-term consequences of inadequate nutrition, and the current global status of nutrition in this age group. Adequate attention and emphasis on nutrition in the school-age years is critical: (a) for maintaining an adequate course of somatic and cognitive development, (b) for taking advantage of this last major opportunity to correct deficits of undernutrition and "catch-up" to normal life course development, and (c) for addressing the nutritional inadequacies and mitigating the longer-term consequences of overnutrition. This review summarizes and provides a rationale for prioritizing nutrition in school-age children, and for the need to revisit priorities and focus on this part of the life cycle to maximize individuals' potential and their contribution to society.
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Affiliation(s)
- Jose M Saavedra
- with the Division of Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Andrew M Prentice
- is with the MRC Unit, The Gambia and MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
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Schott W, Aurino E, Penny ME, Behrman JR. The double burden of malnutrition among youth: Trajectories and inequalities in four emerging economies. ECONOMICS AND HUMAN BIOLOGY 2019; 34:80-91. [PMID: 31248754 DOI: 10.1016/j.ehb.2019.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
As part of the nutritional transition, undernutrition is globally declining while changes brought by economic development have ushered in increases in overweight and its related economic costs and health consequences around the world. We examine trajectories in stunting and overweight from age one year to mid-adolescence and from mid-childhood to early adulthood among two cohorts from Ethiopia, India, Peru and Vietnam using data from the Young Lives study. We examine descriptive data and then model trajectories in stunting and overweight status over age. Group-based trajectory analysis with five ages of overweight and stunting for each country-cohort reveals (1) trajectories of catch-up growth for a subset of study children between the ages of 12 and 19 in the older cohort in Ethiopia (20.1% of the cohort), India (20.5%), Peru (16.9%), and Vietnam (14.0%); (2) trajectories of increasing probabilities of stunting as children age from 12 to 22 in the older cohort in India (22.2%) and Peru (30.7%); (3) trajectories of early (childhood) increases in overweight probabilities (younger cohort: India, 3.4%, Peru, 19.4%, and Vietnam, 8.1%), and of later (adolescence) increases in overweight probabilities (older cohort: Ethiopia, 0.5%, India, 6.3%, Peru, 40.9%, and Vietnam, 9.4%). Multinomial logit prediction of membership in trajectory categories reveals that higher wealth quartiles and maternal schooling are protective against high stunting probability trajectory group membership, but higher wealth and urban residence predict high overweight probability trajectory group membership. This evidence suggests a window of opportunity for interventions to reduce stunting and to avert overweight development in adolescence, in addition to the often-emphasized first 1000 days after conception. A life-course approach to policies and programs to target both undernutrition and overweight should be considered.
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Affiliation(s)
- Whitney Schott
- Population Studies Center, 3718 Locust Walk, University of Pennsylvania, Philadelphia, PA, 19104, USA; A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA.
| | - Elisabetta Aurino
- Department of Management and Centre for Health Economics and Policy Innovations, Imperial College London and Young Lives, University of Oxford, UK.
| | - Mary E Penny
- Instituto de Investigación Nutricional, Av. La Molina 1885, La Molina, Lima, Peru.
| | - Jere R Behrman
- Population Studies Center, 3718 Locust Walk, University of Pennsylvania, Philadelphia, PA, 19104, USA; Economics Department, Ronald O. Perelman Center for Political Science and Economics (PCPSE), 133 South 36th Street, University of Pennsylvania, Philadelphia, PA, 19104-6297, USA.
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Stein AD. Perspective: Growing Up or Growing Out: Growth Faltering in Early Childhood and Subsequent Risk of Overweight. Adv Nutr 2019; 10:557-562. [PMID: 31305909 PMCID: PMC6628840 DOI: 10.1093/advances/nmz030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/22/2019] [Accepted: 03/07/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA,Address correspondence to ADS (e-mail: )
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Varghese JS, Stein AD. Malnutrition among women and children in India: limited evidence of clustering of underweight, anemia, overweight, and stunting within individuals and households at both state and district levels. Am J Clin Nutr 2019; 109:1207-1215. [PMID: 30882139 DOI: 10.1093/ajcn/nqy374] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/07/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In India, the prevalences of stunting and anemia have declined in the last decade, but continue to remain high in many regions, whereas those of overweight and obesity have increased in all age and socioeconomic groups. Determining whether these forms of malnutrition cluster is important for the development of appropriate interventions. OBJECTIVES Our objective was to describe the prevalence of a comprehensive list of dual burdens of malnutrition in individuals and households across the 36 states and 640 districts of India. METHODS We analyzed data from the National Family Health Survey-4, 2015-2016, including 655,156 women aged 15-49 y and 145,653 children aged 6-59 mo in India. We measured the coexistence of 19 combinations of women's anemia, underweight, and overweight and children's stunting, underweight, overweight, and anemia at the individual and household levels. We aggregated this information to the state (n = 36) and district (n = 640) levels. We examined whether the observed dual burden prevalence exceeded the expected prevalence, and whether any such excess was related to household wealth. RESULTS Of the 19 dual burdens examined, 8 had significant excess prevalence at the state level and 5 had significant excess prevalence at the district level. All but 1 of these instances reflected an excess dual burden of undernutrition as opposed to clustering of overweight with a form of undernutrition. Household wealth was not positively associated with any clustering of burdens. CONCLUSIONS While dual burdens of anemia, stunting, and underweight are prevalent, there is no evidence of clustering of overweight with other forms of malnutrition in India.
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA
| | - Aryeh D Stein
- Hubert Department of Global Health, Emory University, Atlanta, GA
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Leroy JL, Frongillo EA. Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence. Adv Nutr 2019; 10:196-204. [PMID: 30801614 PMCID: PMC6416038 DOI: 10.1093/advances/nmy101] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/24/2018] [Accepted: 10/30/2018] [Indexed: 01/05/2023] Open
Abstract
The past decade has seen an unprecedented increase in attention to undernutrition, and drastically reducing child stunting has become a global development objective. The strong focus on linear growth retardation and stunting has enabled successful advocacy for nutrition, but with this focus has come some confusion and misunderstanding about the meaning of linear growth retardation and stunting among researchers, donors, and agencies active in nutrition. Motivated by the belief that a sharp focus will further accelerate progress in reducing undernutrition, we critically reviewed the evidence. The global attention to stunting is based on the premise that any intervention aimed at improving linear growth will subsequently lead to improvements in the correlates of linear growth retardation and stunting. Current evidence and understanding of mechanisms does not support this causal thinking, with 2 exceptions: linear growth retardation is a cause of difficult births and poor birth outcomes. Linear growth retardation is associated with (but does not cause) delayed child development, reduced earnings in adulthood, and chronic diseases. We thus propose distinguishing 2 distinctly different meanings of linear growth retardation and stunting. First, the association between linear growth retardation (or stunting) and other outcomes makes it a useful marker. Second, the causal links with difficult births and poor birth outcomes make linear growth retardation and stunting outcomes of intrinsic value. In many cases a focus on linear growth retardation and stunting is not necessary to improve the well-being of children; in many other cases, it is not sufficient to reach that goal; and for some outcomes, promoting linear growth is not the most cost-efficient strategy. We appeal to donors, program planners, and researchers to be specific in selecting nutrition outcomes and to target those outcomes directly.
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Affiliation(s)
- Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
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FROM BIRTH TO ADULTHOOD: ANTHROPOMETRIC TRAJECTORIES AND THEIR IMPLICATIONS FOR CHRONIC DISEASES IN GUATEMALA. J Biosoc Sci 2018; 51:292-306. [PMID: 30295209 DOI: 10.1017/s0021932018000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this paper was to study nutritional status and growth, as measured by height and weight, over the life course and their connection with chronic diseases in Guatemala, a country with high levels of child undernutrition and adult overnutrition, using data from the Institute of Nutrition of Central America and Panama (INCAP) Nutrition Trial Cohort study. The study sample comprised a birth cohort of 1570 individuals who had data in the original 1969-1977 survey as well as the 2002-2004 follow-up, allowing for an analysis of the nutritional transition from childhood to adulthood. The associations between childhood and adulthood anthropometrics were analysed, and the links of these with chronic disease indicators were assessed using multiple regression analysis and structural equation modelling. Moving upwards in nutritional status from childhood to adulthood was observed frequently in the study population. Unlike sex and place of residence, early anthropometrics were not generally found to be associated with adult body mass index (BMI). However, direct relationships were found between childhood nutritional status and growth and adulthood high-density lipoprotein (HDL) cholesterol, triglycerides and fasting blood glucose. Furthermore, these relationships were not mediated by BMI. The findings were not sensitive to the metric of childhood anthropometrics, as the use of length-for-age, weight-for-age and weight-for-length all resulted in similar conclusions. These relationships demonstrate the importance of early childhood conditions for later-life outcomes. However, the lack of such relationships for blood pressure suggests that the biological links between childhood anthropometrics and various chronic diseases might vary.
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Hanson SK, Munthali RJ, Lundeen EA, Richter LM, Norris SA, Stein AD. Stunting at 24 Months Is Not Related to Incidence of Overweight through Young Adulthood in an Urban South African Birth Cohort. J Nutr 2018; 148:967-973. [PMID: 29767752 PMCID: PMC6669956 DOI: 10.1093/jn/nxy061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/24/2018] [Accepted: 03/11/2018] [Indexed: 11/14/2022] Open
Abstract
Background The role that childhood stunting plays in the development of overweight and obesity later in life is not well understood, particularly in adolescence and young adulthood, because most studies have only followed up through midchildhood. Objective The objective of this study was to examine the relation between stunting and age-specific patterns of overweight and obesity incidence from early childhood to young adulthood in the context of a country in the process of the nutrition transition while these children were growing up. Methods We analyzed data from 895 participants in the Birth-to-Twenty Plus Cohort (Bt20+), an urban South African birth cohort initiated in 1990. Anthropometric data were collected at multiple ages and participants were included if they provided height at age 24 mo and ≥1 measure of body mass index [BMI; weight (kg)/height (m)2] in each of the following time periods: 4-8 y, 11-12 y, 13-15 y, 16-18 y, and 22-24 y. We defined stunting at age 24 mo as height-for-age z score <2 and overweight as BMI z score (BMIZ) >1 in childhood (4-8 y) and adolescence (11-12 y, 13-15 y, and 16-18 y) and BMI ≥25 in young adulthood (22-24 y). We compared BMI, BMIZ, and the prevalence of overweight by stunting status, stratified by sex. Results Our sample was 93% black and 51% female. The prevalence of stunting at 24 mo was 26% in males and 19% in females. In young adulthood, the prevalence of overweight and obesity was 15.5% (men) and 47.5% (women). Among both males and females, neither mean BMI nor a combined measure of overweight and obesity in any subsequent period differed by stunting status at 24 mo (P ≥ 0.05). Conclusion Stunting at 24 mo was not related to the risk of overweight or obesity in this cohort. Stunting may not be an important contributor to the increasing obesity rates in urban South Africa.
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Affiliation(s)
- Sara K Hanson
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School
- Medical Research Council Developmental Pathways for Health Research Unit
| | - Richard J Munthali
- Medical Research Council Developmental Pathways for Health Research Unit
| | - Elizabeth A Lundeen
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School
- Medical Research Council Developmental Pathways for Health Research Unit
| | - Linda M Richter
- Department of Science and Technology and National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Medical Research Council Developmental Pathways for Health Research Unit
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Medical Research Council Developmental Pathways for Health Research Unit
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