Critical windows for nutritional interventions against stunting

Abstract

An analysis of early growth patterns in children from 54 resource-poor countries in Africa and Southeast Asia shows a rapid falloff in the height-for-age z score during the first 2 y of life and no recovery until ≥5 y of age. This finding has focused attention on the period −9 to 24 mo as a window of opportunity for interventions against stunting and has garnered considerable political backing for investment targeted at the first 1000 d. These important initiatives should not be undermined, but the objective of this study was to counteract the growing impression that interventions outside of this period cannot be effective. We illustrate our arguments using longitudinal data from the Consortium of Health Oriented Research in Transitioning collaboration (Brazil, Guatemala, India, Philippines, and South Africa) and our own cross-sectional and longitudinal growth data from rural Gambia. We show that substantial height catch-up occurs between 24 mo and midchildhood and again between midchildhood and adulthood, even in the absence of any interventions. Longitudinal growth data from rural Gambia also illustrate that an extended pubertal growth phase allows very considerable height recovery, especially in girls during adolescence. In light of the critical importance of maternal stature to her children's health, our arguments are a reminder of the importance of the more comprehensive UNICEF/Sub-Committee on Nutrition Through the Life-Cycle approach. In particular, we argue that adolescence represents an additional window of opportunity during which substantial life cycle and intergenerational effects can be accrued. The regulation of such growth is complex and may be affected by nutritional interventions imposed many years previously.

Adolescence and the next generation

“…Less than half of pregnant women in sub-Saharan Africa have an antenatal visit in the first trimester, and rates are lower in adolescents 46 . Although undernutrition has been a major policy focus in maternal health 47 , antenatal interventions with maternal protein-energy or micronutrient supplements have generally brought minimal changes to birth weight 10 . One probable reason is that interventions are taking place too late in pregnancy 48 .…”

“…Puberty initiates a phase of growth and maturation of the reproductive, musculoskeletal, neurodevelopmental, endocrine, metabolic, immune and cardio-metabolic systems, that extends into the third decade 9,10 . For this reason, adolescence can be considered a sensitive phase, during which the quality of the physical, nutritional and social environments may change trajectories of health and development into later life 11 .…”

“…This is surprising, given that adolescents are the next generation to become a parent and we have known for decades that preconception maternal nutrition (for example, folate deficiency) 16 and infectious diseases 17,18 affect the early life health and development of offspring. Indeed, a failure to consider influences on growth during early life that emerge in adolescence before conception may explain why antenatal interventions have too often only led to small gains 10,19 .…”

Pengaruh Edukasi Gizi terhadap Feeding Practice Ibu Balita Stunting Usia 6-24 Bulan (The Effect of Nutritional Knowledge on Feeding Practice of Mothers Having Stunting Toddler Aged 6-24 Months)

“…Adanya catch-up setelah usia 24 bulan merefleksikan ketersediaan makanan, pola konsumsi, komposisi zat gizi yang cukup serta terhindar dari infeksi. Dengan demikian edukasi gizi harus juga ditekankan pada pencegahan terhadap infeksi [14,15].…”

Linear Growth and Child Development in Low- and Middle-Income Countries: A Meta-Analysis

“…A partial explanation may be that the biologically relevant time period during which malnutrition acts on child development is during infancy or early toddlerhood, and because of growth catch-up the association is diluted at older ages. 91 Studies examining changes in HAZ over time also suggest that early growth catchup or reversal of stunting status is associated with improved cognition. 22,35,58,69,82 Another possible mechanism is that chronic infection or protein energy malnutrition may delay or prohibit advancement of early motor skills, which then leads to cognitive delays by way of reduced ability of the child to explore and extract learning opportunities from the physical and social environment.…”