Early childhood growth failure and the developmental origins of adult disease: do enteric infections and malnutrition increase risk for the metabolic syndrome?

Abstract

Hypotheses regarding the developmental origins of health and disease postulate that developing fetuses–and potentially young children—undergo adaptive epigenetic changes with longstanding effects on metabolism and other processes. Ongoing research explores whether these adaptations occur during early life following malnutrition. In the developing world there remains a high degree of nutritional stunting—linear growth failure due to inadequate calories that may be exacerbated by inflammation from ongoing infections. In areas with poor sanitation children experience vicious cycles of enteric infections and malnutrition, resulting in poor nutrient absorption from intestinal mucosa changes now termed “environmental enteropathy.” Emerging evidence links early childhood diarrhea and/or growth failure with increased CVD risk factors in later life, including dyslipidemia, hypertension and glucose intolerance. The mechanisms for these associations remain poorly understood and may relate to epigenetic responses to poor nutrition, increased inflammation or both. Given increases in CVD in developing areas of the world, associations between childhood malnutrition, early life infections and increased CVD risk factors underscore further reasons to improve nutrition and infection-related outcomes for young children worldwide.

Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala

“…However, within the Americas, the Central American Republic of Guatemala has the highest rate of stunting, with a 49·8 % prevalence according to the most recent national nutrition survey (3) , when measured with respect to the WHO standards (4) . The designation of stunting as 'chronic malnutrition' would implicitly suggest a dietary origin, but a diverse series of environmental influences including microbial contamination (5) , mycotoxins (6,7) , indoor smoke (8) , recurrent diarrhoea (9,10) , helminth infection (11,12) and environmental enteric dysfunction (13,14) have been postulated to explain more of the variance than can be explained simply by poor nutrient intake (5,15) . On a global basis, UN statistics document a progressive and steep decline in length-for-age status during the first three years of life (16) .…”

Growth Trajectories of Refugee and Nonrefugee Children in the United States

“…Stunted children living in countries undergoing a nutrition transition (ie, a shift in dietary consumption coinciding with economic changes and urbanization) have an increased risk of obesity, metabolic syndrome and cardiovascular disease in adulthood. 39,40 The coexistence of stunting and overweight has been described in many populations worldwide, 14 and is important to consider among individuals immediately transitioning into the US nutrition environment through migration.…”

Reducing neurodevelopmental disorders and disability through research and interventions

“…In other words, as people's environment improves, the role and prominence of genetic and genomic factors will increase. Common disorders include conditions that are attributable to epigenetic influences 68 (for example, DNA methylation and histone modification).…”