How Much Nutrition for How Much Growth?

Abstract

Background/Aims: Increasing agreement exists about the use of length-for-age as the indicator of choice in monitoring the long-term impact of chronic nutritional deficiency. Yet, already shortly after World War I, a causal link between nutrition and growth was questioned. Also, modern meta-analyses of controlled nutrition intervention studies show that the net effect of nutrition on body height is small. Broad evidence obtained from historic observations on human starvation made since the 19th century questions an obligatory association between nutrition and growth. Many additional explanations for the apparent shortness of people from developing countries have been published since, focusing on genetic factors, environment, economy, epigenetics, and, recently, psychosocial factors, such as strategic growth adjustments suggesting stature to be a social signal. Conclusion: The marked variability in average population height of up to 20 cm within a few generations complicates the use of normative growth charts, even though they have been widely propagated. We support the concept of local growth references, for example using the “Synthetic Growth References” methodology. These references combine local growth information obtained from a given population of interest and common features of human population growth, with LMS values for height, weight, and BMI from birth to maturity.

Stunting is not a synonym of malnutrition

“…[16, p. 1000-1001]. But reversing the line of argument by connecting short stature with shortage of food, lacks substantiation [17]. Scheffler et al [18] re-analyzed cross-sectional growth studies of middle-class school children performed in Kolkata, India, and failed to detect an association between nutritional status (as indicated by skinfold thickness) and body height [19].…”

As tall as my peers – similarity in body height between migrants and hosts

“…This is a sharp contrast to Boas' words, but Spier did not mention sources supporting his statements, nor did he report on his own findings to support his statements on migrant growth. The potential 'eminent role' of nutrition on growth has since been re-echoed many times and is the basis of contemporary nutrient intervention trials to prevent growth stunting (Goudet et al 2016;Aguayo & Menon 2016;Hermanussen & Wit 2017).…”

Stunting, starvation and refeeding: a review of forgotten 19th and early 20th century literature

“…Even socioeconomically disadvantaged children, when supplemented, only grew an average of 0.27 cm more over 6 months than those who were not supplemented . The data did not question that severe starvation coincides with growth inhibition, but the net effect of nutrition on body height was generally small . Goudet et al reviewed interventions to tackle malnutrition and its risk factors in children living in urban slums.…”