The stunting syndrome in developing countries

Prendergast, Andrew J.; Humphrey, Jean H.

doi:10.1179/2046905514y.0000000158

Cited by 817 publications

(853 citation statements)

References 248 publications

(261 reference statements)

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“…Greater socio-economic inequalities also appear to exist in countries with a high prevalence of stunting, which further impacts on the development of stunting in children. 4 Boys appear to be more likely to be stunted than girls in sub-Saharan Africa. 5 Although South Africa is food secure at national level, more than half of households in the country experience, or are at risk of, hunger.…”

Section: Introductionmentioning

confidence: 99%

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Steenkamp

Lategan

Raubenheimer

2016

South African Journal of Clinical Nutrition

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Objectives: The objective of the study was to describe wasting and stunting in children aged 12-60 months, admitted to targeted supplementary feeding programmes for the treatment of moderate acute malnutrition (MAM) in South Africa.Design: A cross-sectional, descriptive study was performed.Subjects and setting: Children with MAM, managed as outpatients at primary healthcare facilities in three provinces, were included in the study conducted between September 2012 and August 2013.Outcome measures: Weight, height and mid-upper-arm circumference (MUAC) measurements were collected to classify the children as moderately or severely stunted or wasted.Results: Of the total sample (n = 225), 13% (n = 30) were diagnosed as wasted, 58% (n = 131) as stunted, and 21% (n = 47) as both wasted and stunted. MUAC was significantly associated with wasting. However, an association was not found between MUAC and stunting. Of the sample, 32% (n = 72) presented with severe stunting, and 29% (n = 65) with moderate wasting. Food insecurity was associated with wasting, but not with stunting. Conclusion:A low weight-for-age z-score resulted more from stunting than from wasting in this study. Severe stunting presented as a greater health concern than moderate wasting. Without scrutinising wasting and stunting, healthcare professionals may remain unaware of the drivers of underweight for age in children treated at South African primary healthcare facilities. Following this study's outcomes, the sensitivity of MUAC in screening for moderate malnutrition in South African settings with a high prevalence of stunting is questionable. It is recommended that current nutritional interventions are revisited to explore the efficacy of treating children with wasting, stunting or both.Peer reviewed.

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Section: Introductionmentioning

confidence: 99%

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Steenkamp

Lategan

Raubenheimer

2016

South African Journal of Clinical Nutrition

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“…44 The findings in this series of reports from a single setting not only illustrate the intergenerational perpetuation of malnutrition and its effects in that particular context, but also represent a scenario that is common to impoverished environments with poor hygiene and sanitation and limited access to high-quality health care in addition to malnutrition. 16,45 It is important to note that malnutrition includes not only undernutrition, but also overnutrition (eg, overweight/ obesity), which might consist of an excess of calories and an overweight status but with micronutrient deficiencies due to the consumption of foods of poor nutritional quality. Therefore, malnutrition refers to poor nutritional quality, including micronutrient deficiencies in both over-and undernutrition.…”

Section: Figurementioning

confidence: 99%

Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings

et al. 2017

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The rapid pace of fetal development by far exceeds any other stage of the life span, and thus, environmental influences can profoundly alter the developmental course. Stress during the prenatal period, including malnutrition and inflammation, impact maternal and fetal neurodevelopment with long-term consequences for physical and mental health of both the mother and her child. One primary consequence of maternal malnutrition, inflammation, and other sources of prenatal stress is a poor birth outcome, such as prematurity or growth restriction. These phenotypes are often used as indications of prenatal adversity. In fact, the original evidence supporting the fetal programming hypothesis came from studies documenting an association between birth phenotype and the development of subsequent physical and mental health problems. Fetal growth restriction in both term and preterm infants is associated with neonatal morbidities and a wide variety of behavioral and psychological diagnoses in childhood and adolescence, including attention-deficit/hyperactivity disorder, anxiety, depression, internalizing and thought problems, poor social skills, and autism spectrum disorder. Improving maternal–child health requires interventions that begin before pregnancy and continue throughout gestation and into the postpartum period. Such interventions might include supporting pregnancy intention, maternal nutrition, health/medical care, mental health, and providing social support. This article discusses the impact of maternal nutrition and inflammation during preconception and pregnancy among women living in low-resource settings, with an emphasis on key knowledge gaps that need to be addressed to guide program and policy decisions at local, regional and global levels.

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“…Although it is by definition asymptomatic, EED in children is strongly associated with growth stunting and poor developmental outcomes [1][2][3][4] . The syndrome manifests as a global disturbance of gut function, leading to impaired intestinal barrier function and poor uptake of nutrients [2][3][4] . Environmental origins are suspected, but the aetiology is still not well understood and the most effective route to prevention and treatment remains unclear 5,6 .…”

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confidence: 99%

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Thompson

Hughes

Anastasova

et al. 2017

Nat Rev Gastroenterol Hepatol

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| Environmental enteric dysfunction (EED) is a disease of the small intestine affecting children and adults in low and middle income countries. Arising as a consequence of repeated infections, gut inflammation results in impaired intestinal absorptive and barrier function, leading to poor nutrient uptake and ultimately to stunting and other developmental limitations. Progress towards new biomarkers and interventions for EED is hampered by the practical and ethical difficulties of cross-validation with the gold standard of biopsy and histology. Optical biopsy techniques -which can provide minimally invasive or noninvasive alternatives to biopsy -could offer other routes to validation and could potentially be used as point-of-care tests among the general population. This Consensus Statement identifies and reviews the most promising candidate optical biopsy technologies for applications in EED, critically assesses them against criteria identified for successful deployment in developing world settings, and proposes further lines of enquiry. Importantly, many of the techniques discussed could also be adapted to monitor the impaired intestinal barrier in other settings such as IBD, autoimmune enteropathies, coeliac disease, graft-versus-host disease, small intestinal transplantation or critical care. Members of the board and experts met to discuss the horizon scan in London, UK, in November 2015 and San Francisco, USA, in February 2016. Literature searches were performed using Web of Science, as well as through the advice of the advisory board and experts. The results of the horizon scan are presented in this Consensus Statement, which entails a review of EED, a discussion of technologies deemed relevant to EED (based on literature searches and the opinions of the advisory board and experts), and a series of recommendations for the future application of the rele vant technologies to the study and diagnosis of EED. In the Recommendations section, each technology has been assessed according to its suitability for application to EED and this assessment includes an evaluation of the cost, invasiveness and appropriateness for developing countries of each device and/or technique. This assessment was performed in a qualitative manner based on currently available information (for example, the present cost and size of the devices) and the opinions of the authors as to feasible future develop ment. Technique suitability for use in developing countries was determined in a qualitative manner after consideration of the need for advanced infrastructure and high levels of training for either system use or data analysis. Probable deployment time scales have also been assigned to each technique based on the current states of development and the degree of valid ation work that will be required before application to EED. These timescales have been tentatively defined as short-term (suitable for deployment immediately or within ~1 year), mediumterm (suit able for deployment within ~1-3 years) and long-term (suitable for deployme...

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The stunting syndrome in developing countries

Cited by 817 publications

References 248 publications

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

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