ABSTRACT. Objective. 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.Methodology. 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.Results. 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.Conclusions. These findings highlight the need for prenatal and early life interventions to prevent growth failure. Pediatrics 2001;107(5). URL: http://www. pediatrics.org/cgi/content/full/107/5/e75; growth, body height, body weight, infant nutrition disorders, child nutrition disorders.ABBREVIATIONS. UNICEF, United Nations Children's Fund; WHO, World Health Organization; NCHS, National Center for Health Statistics; SD, standard deviation; NHANES, National Health and Nutrition Examination Survey; IMCI, Integrated Management of Childhood Illnesses. S tunting affects 182 million (33%) and being underweight affects 150 million (27%) of the world's children 1 ; these are associated with over half of the 10 million annual deaths of children under 5 years. 2 Developing countries account for almost all of this burden, with 70% of all early child mortality and malnutrition concentrated in subSaharan Africa and South Asia. Despite setting a goal of reducing malnutrition by 50% at the World Summit for Children, 3 few countries in these 2 regions will have been successful in achieving this goal by the end of the decade. It is our contention that one of the reasons for failure is the lack of clear definition and common understanding of what the problem is. The purpose of this article is to try to bring more clarity to these issues.Waterlow 4 proposed a functional classification for child malnutrition that separated children who had acute malnutrition from those with chronic malnutrition. The acutely malnourished children were those with adequate height for age but inadequate weight for height (wasted). The chronically malnourished children were those that had inadequate height for age (stunted). Chronically malnourished children could also be acutely malnourished, in which case they would be both stunted and wasted. The Waterlow Classification was c...

Leucine catabolism is regulated by either of the first two degradative steps: (reversible) transamination to the keto acid or subsequent decarboxylation. A method is described to measure rates of leucine transamination, reamination, and keto acid oxidation. The method is applied directly to humans by infusing the nonradioactive tracer, L-[15N,1-13C]leucine. Leucine transamination was found to be operating several times faster than the keto acid decarboxylation and to be of equal magnitude in adult human males under two different dietary conditions, postabsorptive and fed. These results indicate that decarboxylation, not transamination, is the rate-limiting step in normal human leucine metabolism.

Rates of synthesis and breakdown of body protein and oxidation of leucine were measured in six obese subjects by constant intravenous infusion of (1 14C)leucine for 24-hr periods. During the night, when no food was given, the rate of whole body protein synthesis was 67% of the rate observed furing the day, when food was given hourly. By contrast the rate of body protein breakdown remained constant over the full 24 hr. This resulted in the immediate deposition of about 30% of the protein intake during the day, whereas the remaining 70% was immediately oxidized. At night the rate of protein oxidation fell to only 38% of its daytime value. The rate of oxygen consumption also decreased at this time so that the contributon of protein oxidation to total energy expenditure fell from 27% during the day to 13% at night. These changes reflect the normal, discontinuous pattern of food intake and the need during feeding to store protein in tissues for use in subsequent periods of fasting.

The world's demand for food is becoming greater than ever. The current world population of 6 billion will exceed 8 billion in 2025 and new innovations are needed to meet the growing challenges of the poor and hungry world. Novel foods produced through biotechnology may help alleviate the problems of poverty and food insecurity, but only if steered by continual policy development and actions at the regional, national and international levels. The great progress made with iodized salt in combatting iodine deficiency disorders, through global partnership, provides inspiration for future applications of nutritional science and food technology to public health problems in the developing world. The attributes of biotechnology‐produced novel foods are complex. As outlined in the present paper, they may also provide the diets of people in developing countries with more energy, protein and micronutrients. This could thereby reduce the extent of suffering associated with public health problems such as vitamin A deficiency and iron deficiency and anaemia, which affect millions. However, more research and resources need to be focused on the problems and opportunities that face small farmers and poor consumers in developing countries. In particular, attention should be focused on the foods that feature most predominately in their diets such as bananas, cassava, sweet potatoes, rice, maize, wheat, millet and yams, and unless this exciting science is given a chance to prove itself in the developing world we will never know if it is in fact the so‐called ‘biosolution’. Paradoxically, overnutrition, obesity, and related diseases characteristic of the developed world, are becoming serious public health problems in countries with widespread food insecurity. Children suffering from undernutrition today could well be afflicted with chronic diseases of development as adults. The economic development that has led to improved food security and better health in some countries needs to be harnessed, while at the same time incentives to avert the adverse health effects of the nutrition transition need to be taken. The potential of novel foods to alleviate undernutrition is becoming more apparent. But they are unlikely to have a role in the prevention of diseases associated with overnutrition in developing countries, who use growing incomes to replace their traditional diets high in complex carbohydrates and fibre, with diets that include a greater proportion of fats (especially saturated) and sugars. More aggressive public health policies are needed to steer populations in nutrition transition towards a healthy lifestyle and diet rather than investing in particular novel foods. In developed countries the wide variety of macronutrient‐modified foods available to consumers has enabled people to eat a more healthy diet, along the lines of the recommendations issued by many governments, and so reduce the risk of diseases such as obesity, cardiovas­cular disease and cancer. Novel foods containing macronutrient substitutes can be a useful adjunc...

1. Nine adult subjects (eight obese, one normal) were infused with NaH14CO3 for up to 36 h. 2. The recovery of label as respiratory 14CO2 was close to 90% throughout and did not change with feeding or with dietary composition.