Portal de Periódicos da CAPES

Stunted growth

2016; Springer Nature; Volume: 70; Issue: 6 Linguagem: Inglês

10.1038/ejcn.2016.47

1476-5640

Michael Hermanussen,

Child Nutrition and Water Access

Evidence that body height is determined by socioeconomic circumstances can be traced back to Louis René Villermé (1782-1863), a French hygienist who used data collected by the military services of the French army in 1812 and 1813, and the report to the Minister of War in 1817.In 1829 (cited by Boyd 1 ), he published that 'the stature of man becomes higher, and growth is completed earlier, all things being equal, when the country is rich, and comfort widespread; when clothing and especially food are good, and when difficulties, fatigues and privations experienced in childhood and youth are few.In other words, poverty, that is to say the circumstances accompanying it, produces short stature and retards the period of complete development of the body'.Even though Villermé did not literally mention health status, the terms 'difficulties, fatigues and privations' may be interpreted in this sense.The significance of his words has remained relevant since.In the second half of the 19th century, the laws of genetics became apparent completing the four basic conditions known to us for appropriate human growth-genetics, nutrition, health, and the psycho-social and economic circumstances.Maternal health and prenatal development have recently been added as additional conditions for appropriate growth and later health.In 2013, Christian et al. 2 summarised evidence that low birthweight was associated with 2.5-3.5-foldhigher odds of wasting, stunting and underweight.The population attributable risk for overall small-for-gestational age (SGA) for outcomes of childhood stunting and wasting was shown to be 20 and 30%, respectively.Villermé's statement 'poverty, that is to say the circumstances accompanying it, produces short stature' is valid.Ample evidence suggests that, at the population level, the association between stature and poverty is statistically significant.This has prompted the assumption that shortness of stature may be an appropriate tool for detecting poverty and accompanying circumstances, and that improvements in growth may be valid indicators for the efficacy of health and nutrition interventions.Yet, we feel that such assumptions may still be premature.Shortness of stature is relative.Defining shortness requires a reference.However, which reference is appropriate?The World Health Organization (WHO) designed a Multicentre Growth Reference Study, a community-based, multi-country project, performed on populations raised under conditions favourable to growth, that is, single-term birth, appropriate feeding, with no apparent health or environmental constraints on growth, such as maternal smoking or significant morbidity. 3The design combined a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18-71 months. 4The design is based on a selected population raised under favourable conditions and thus no longer describes how children grow (descriptive reference), but how children should grow (prescriptive standard) if raised under optimum circumstances.By April 2011, already 125 countries had adopted these prescriptive standards.Weight-for-age was adopted almost universally, followed by length/height-for-age (104 countries) and weight-for-length/ height (88 countries) to optimally realise 'the children's right to achieve their full genetic growth potential'. 5et, many of these countries are populated by people who greatly differ in height and weight from these references.