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Exploring the Nutritional Ecology of Stunting: New Approaches to an Old Problem

Published on Jan 31, 2020in Nutrients4.171
· DOI :10.3390/NU12020371
Daniel J Raiten16
Estimated H-index: 16
(NIH: National Institutes of Health),
Daniel J. Raiten + -1 AuthorsAndrew A. Bremer27
Estimated H-index: 27
(NIH: National Institutes of Health)
Sources
Abstract
Despite a declining prevalence, stunting remains an elusive target for the global health community. The perception is that stunting represents chronic undernutrition (i.e., due to inadequate nutrient intake associated with food insecurity, low-quality diet, and suboptimal infant feeding practices in the first two years of life). However, other causes include maternal–fetal interactions leading to intrauterine growth retardation, poor maternal nutrition during pregnancy and lactation, and maternal and pediatric infections. Moreover, physical, economic, demographic, and social environments are major contributors to both food insecurity and conditions that limit linear growth. Overall, factors representing both the internal and external “nutritional ecologies” need to be considered in efforts to reduce stunting rates. Nutritional assessment requires better understanding of the mechanism and role of nutrition in growth, clear expectations about the sensitivity and specificity of the tools used, and inclusion of bio-indicators reflecting the extent and nature of the functional effect of poor nutrition and environmental factors contributing to human physical growth. We provide a perspective on current knowledge about: (i) the biology and contribution of nutrition to stunting/poor growth; (ii) our current nutritional assessment toolkit; (iii) the implications of current assessment approaches for clinical care and public interventions; and (iv) future directions for addressing these challenges in a changing global health environment.
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References37
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#1Kirkby D. Tickell (UW: University of Washington)H-Index: 4
#2Hannah E Atlas (UW: University of Washington)H-Index: 2
Last. Judd L. WalsonH-Index: 24
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Environmental enteric dysfunction (EED) is an acquired enteropathy of the small intestine, characterized by enteric inflammation, villus blunting and decreased crypt-to-villus ratio. EED has been associated with poor outcomes, including chronic malnutrition (stunting), wasting and reduced vaccine efficacy among children living in low-resource settings. As a result, EED may be a valuable interventional target for programs aiming to reduce childhood morbidity in low and middle-income countries. Se...
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#1Iqbal Mahmud (UF: University of Florida)H-Index: 2
#2Mamun KabirH-Index: 21
Last. Timothy J. Garrett (UF: University of Florida)H-Index: 21
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Child malnutrition (CM) is a global public health problem. It contributes to poor health in one in four children under five years worldwide and causes serious health problems in children, including stunted, wasted, and overweight growth. These serious public health issues lead to a higher chance of living in poverty in adulthood. Malnutrition is related with reduced economic productivity and increases the serious national and international burden. Currently, there is no meaningful therapeutic in...
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#1Sheila Isanaka (Harvard University)H-Index: 14
#2Matt D.T. Hitchings (Harvard University)H-Index: 3
Last. Rebecca F. GraisH-Index: 30
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#1Oliver Cumming (Lond: University of London)H-Index: 20
#2Benjamin F. Arnold (University of California, Berkeley)H-Index: 22
Last. John M. Colford (University of California, Berkeley)H-Index: 43
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Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations’ Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners. ...
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#1Simon Schoenbuchner (Medical Research Council)H-Index: 2
#2Carmel DolanH-Index: 6
Last. Sophie E. Moore (Lond: University of London)H-Index: 40
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Background: The etiologic relationship between wasting and stunting is poorly understood, largely because of a lack of high-quality longitudinal data from children at risk of undernutrition. Objectives: The aim of this study was to describe the interrelationships between wasting and stunting in children aged <2 y. Methods: This study involved a retrospective cohort analysis, based on growth-monitoring records spanning 4 decades from clinics in rural Gambia. Anthropometric data collected at sched...
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#1Edward A. Frongillo (USC: University of South Carolina)H-Index: 65
#2Jef L. Leroy (IFPRI: International Food Policy Research Institute)H-Index: 20
Last. Karin Lapping (FHI 360)H-Index: 1
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#1Jef L. Leroy (IFPRI: International Food Policy Research Institute)H-Index: 20
#2Edward A. Frongillo (USC: University of South Carolina)H-Index: 65
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#1Hallgeir Kismul (University of Bergen)H-Index: 3
#2Pawan AcharyaH-Index: 9
Last. Anne Hatløy (Fafo Foundation)H-Index: 10
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Background Prevalence of child stunting in the Democratic Republic of Congo (DRC) is among the highest in the world. There is a need to systematically investigate how stunting operates at different levels of determination and identify major factors contributing to the development of stunting. The aim of this study was to look for key determinants of stunting in the DRC.
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#1Kaitlyn M. Harper (UBC: University of British Columbia)H-Index: 1
#2Maxine Mutasa (SFU: Simon Fraser University)H-Index: 1
Last. Amee R. Manges (UBC: University of British Columbia)H-Index: 25
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Background Environmental enteric dysfunction (EED) is commonly defined as an acquired subclinical disorder of the small intestine, characterized by villous atrophy and crypt hyperplasia. EED has been proposed to underlie stunted growth among children in developing countries. A collection of biomarkers, organized into distinct domains, has been used to measure different aspects of EED. Here, we examine whether these hypothesized relationships, among EED domains and between each domain and stuntin...
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