Lower resting metabolic rate and higher velocity of weight gain in a prospective study of stunted vs nonstunted girls living in the shantytowns of São Paulo, Brazil

Abstract

Objective: Previous studies have shown that stunting increases the risk of obesity in developing countries, particularly among girls and women, but the underlying reasons are not known. This study aimed to investigate the relationship between stunting, weight gain, and resting metabolic rate. Design and subjects: A prospective study was conducted over 36 months with girls from shantytowns in São Paulo, Brazil. A total of 15 stunted girls (S) were compared with 15 nonstunted (N) ones of similar weight for height ratio. Interventions: Resting metabolic rate was measured using indirect calorimetry, and the socioeconomic status was determined by interviews in the household. In addition, body composition was measured by skinfold thickness, while the growth rate was calculated dividing the change in weight and the change in height by the follow-up period. Results:The results of the present study, when combined, revealed that the S group had a lower resting metabolic rate throughout the follow-up period with the differences being significant at 24 and 36 months of follow-up, associated with an increase in the rate of weight gain and a decrease in lean mass, when compared to the N group. Conclusions: These changes are known to be risk factors for obesity and may help to explain the particularly higher prevalence of obesity in women in urban areas of developing countries.

Overweight with concurrent stunting in very young children from rural Mexico: prevalence and associated factors

“…In addition, we show that one-tenth of indigenous children are concurrently stunted and overweight or obese, which is directly tied to low levels of SES. Given the link between childhood stunting and the increased risk of chronic disease in adulthood (Sawaya et al, 2003), the combination of stunting and overweight in early childhood that we report here is likely to increase even further the health risks for these children in later life (Grillol et al, 2005). Overweight and obesity are now major public health concerns in Mexico, even among pre-school children from very low-income families living in rural areas.…”

BMI, body fat and waist-to-height ratio of stunted v. non-stunted Indian children: a case–control study

“…This tendency is referred to as 'metabolic adaptation' or 'poststarvation obesity' (40) . In a prospective study, Grillo et al (41) found that stunted children gained 6 kg/year while the non-stunted children maintained at 4 kg/year irrespective of both groups consuming similar diets. This was because during the follow-up period there was a lesser increase in RMR but a greater increase in the velocity of weight gain in the stunted group compared with the non-stunted group.…”

Relationship between short stature and obesity in Brazil: a multilevel analysis

“…In addition, associations among women have only been observed in studies conducted in the developed regions of the country, suggesting that a minimum of food availability or the kind of food availability present in developed urban centres would be required for the expression of a possible metabolic programming at an early age (10) . In a recent study, a more accurate marker of early undernutrition -the ratio of height to sitting height -was also associated with a high percentage of fat and obesity in a survey of Brazilian women (11) .A possible physiological mechanism to explain these associations is low energy expenditure among women exposed to energy restriction during development, as shown for Brazilian adolescents with stunting (12,13) . A complementary rather than alternative hypothesis in explaining the effects of early undernutrition is that promotion of growth by increased postnatal nutrition increases later risk as observed in a randomised trial of CVD (14) .…”