Worldwide Timing of Growth Faltering: Implications for Nutritional Interventions

Abstract

ABSTRACT. Objective. It is widely assumed that growth faltering starts at around 3 months of age, but there has been no systematic assessment of its timing using representative national datasets from a variety of countries.Methodology. The World Health Organization Global Database on Child Growth and Malnutrition includes the results of 39 nationally representative datasets from recent surveys in developing countries. Based on these data, mean z scores of weight for age, length/height for age, and weight for length/height were compared with the National Center for Health Statistics and Cambridge growth references, for children younger than 60 months.Results. Mean weights start to falter at about 3 months of age and decline rapidly until about 12 months, with a markedly slower decline until about 18 to 19 months and a catch-up pattern after that. Growth faltering in weight for length/height is restricted to the first 15 months of life, followed by rapid improvement. For length/height for age, the global mean is surprisingly close to National Center for Health Statistics and Cambridge references at birth, but faltering starts immediately afterward, lasting well into the third year.Conclusions. These findings highlight the need for prenatal and early life interventions to prevent growth failure. Pediatrics 2001;107(5). URL: http://www. pediatrics.org/cgi/content/full/107/5/e75; growth, body height, body weight, infant nutrition disorders, child nutrition disorders.ABBREVIATIONS. UNICEF, United Nations Children's Fund; WHO, World Health Organization; NCHS, National Center for Health Statistics; SD, standard deviation; NHANES, National Health and Nutrition Examination Survey; IMCI, Integrated Management of Childhood Illnesses. S tunting affects 182 million (33%) and being underweight affects 150 million (27%) of the world's children 1 ; these are associated with over half of the 10 million annual deaths of children under 5 years. 2 Developing countries account for almost all of this burden, with 70% of all early child mortality and malnutrition concentrated in subSaharan Africa and South Asia. Despite setting a goal of reducing malnutrition by 50% at the World Summit for Children, 3 few countries in these 2 regions will have been successful in achieving this goal by the end of the decade. It is our contention that one of the reasons for failure is the lack of clear definition and common understanding of what the problem is. The purpose of this article is to try to bring more clarity to these issues.Waterlow 4 proposed a functional classification for child malnutrition that separated children who had acute malnutrition from those with chronic malnutrition. The acutely malnourished children were those with adequate height for age but inadequate weight for height (wasted). The chronically malnourished children were those that had inadequate height for age (stunted). Chronically malnourished children could also be acutely malnourished, in which case they would be both stunted and wasted. The Waterlow Classification was c...

Overweight among children decreased, but obesity prevalence remained high among women in South Africa, 1999–2005

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