Long-Lasting Effects of Undernutrition

Abstract

Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity.

‘The abiding condition was hunger’: assessing the long-term biological and health effects of malnutrition and hunger in Canada’s residential schools

“…This cascade of effects leads almost inexorably to a complex of obesity, hypertension, and diabetes. The effects are not reversed once adequate diets are re-established; rather, the individual's physiology has been programmed, in a sense, by childhood deprivation to continue the cycle of worsening effects (Florêncio et al 2004;Martins et al 2011;. This process matches descriptions of famine survivors emerging from observational studies of post-famine cohorts.…”

“…Children whose growth falters due to malnutrition have lower fat-free mass, impaired bone development, and a tendency to prioritise fat-over lean-mass deposition (Martins et al 2011;. Stunted adolescents exhibit lower insulin levels and greater insulin sensitivity than non-stunted controls and are therefore at greater risk of developing Type II diabetes (Martins and Sawaya 2006).…”

“…The effects of stunting on adult employment are well documented. Cohort studies demonstrate reduced work capacity among adults who experienced height stunting through childhood exposures (Martins et al 2011) and lower income levels among height-stunted individuals (Chen and Zhou 2007;Dewey and Begum 2010;Victoria et al 2008).…”

“…Nutritional deprivation activates the hypothalamic-pituitary-adrenal stress response, causing a prolonged increase in cortisol secretion. An elevated cortisol level is exacerbated by the reduced rate of metabolic clearance of circulating cortisol due to lower basal metabolic rate (Martins et al 2011;. Elevated cortisol further blunts insulin response, inhibits the function of insulin-like growth factor (IGF-1), and produces long-term changes in lipid metabolism (Martins et al 2011), thereby worsening growth impairment and further increasing risk of obesity and chronic disease.…”

Developing and Testing the Acceptability of Therapeutic Food for the Management of Severely Malnourished Children

“…Undernutrition in the wider perspective is persistent adherence to inefficient nutrition in terms of the quantity and quality of the food intake coupled with infections [7]. Undernutrition can either be acute or chronic depending on the duration of the infection and/or inadequate nutrient intake by the child.…”