Stunting and future risk of obesity: principal physiological mechanisms

Abstract

There is a fair amount of epidemiological evidence showing that nutritional stunting causes increased risks of obesity. Obesity is increasing dramatically not only in developed countries but also in developing countries, such as Brazil, especially among the poorer. The mere coexistence of undernutrition and obesity among poor people has a great impact, as the burden in the social, economic, and health care systems is remarkable. In addition, an increasing number of studies have shown that nutritional stunting causes a series of important long-lasting changes such as lower energy expenditure, higher susceptibility to the effects of high-fat diets, lower fat oxidation, and impaired regulation of food intake. These findings suggest that a broader and more detailed understanding of the long-lasting effects of early undernutrition, direct cause of nutritional stunting, is needed. Within this context, we present data of some physiological mechanisms that substantiate the association between previous undernutrition and future obesity.

Crescimento físico e perfil nutricional da população indígena Xavánte de Sangradouro-Volta Grande, Mato Grosso, Brasil

“…Em povos indígenas situados no Brasil, apesar do problema ainda não atingir as proporções verificadas entre indígenas da Améri-ca do Norte, há um crescente número de estudos que apontam para a emergência da obesidade, diabetes mellitus tipo II e doenças cardiovasculares, que têm em comum o fato de estarem atravessando profundas alterações em seus sistemas de subsistência, dieta e padrões de atividade física 2,5,8,10,11,13,14 A coexistência de elevadas prevalências de desnutrição em crianças e sobrepeso e obesidade em adultos, tal como observado entre os Xavánte, assume uma dimensão particularmente preocupante face às evidências de que podem haver relações estreitas entre déficits estaturais na infância e risco de obesidade futura 35,36,37 . Os mecanismos envolvidos nessa interação não são bem conhecidos, mas possivelmente envolvem menor gasto energético, maior suscetibilidade aos efeitos de dietas com alto teor de gorduras, menor oxidação de gorduras e prejuízo na regulação da ingestão alimentar associados à desnutrição, favorecendo a médio e longo prazo o desenvolvimento de sobrepeso e obesidade 37 . Portanto, além da conjunção de condições alimentares e os de padrões de atividade física que podem estar contribuindo para o quadro de expansão da obesidade entre os Xavánte a curto prazo, a ampla distribuição da desnutrição em crianças pode ser um agravante a médio e a longo prazo.…”

Fatness and overweight in women and children from riverine Amerindian communities of the Beni River (Bolivian Amazon)

“…The existence of a link between stunting and fatness was postulated in previously malnourished children from Brazil (Sawaya and Roberts 2003). Likewise, several observations from Latin 14…”

“…Moreover, fat distribution, 2 especially higher fat accumulation on the trunk in early adolescence , is an acknowledged risk factor for metabolic diseases during adulthood (Malina and others 1999). 4 Hence, the main objective of this paper was to present data on overweight and obesity in children 6 and women in a population leading a "traditional" way of life in the Beni department (lowland Bolivia). In addition, we sought to elucidate the role of environmental, familial and individual 8 factors in the risk of overweight.…”

Coexistence of maternal central adiposity and child stunting in Mexico

“…This phenomenon could explain the coexistence of maternal overweight and child stunting (CS) as part of the same process at different stages in the life cycle. 17 A number of reports have described an association of stunting and obesity within the same households and in mother-child pairs. [1][2][3] A study on 535 families from shantytowns of São Paulo, Brazil, found that obesity associated with stunting was more common than obesity without stunting.…”