Stunted growth

Question 1

Primary malnutrition

Answer 1

lack of/poor quality food

Question 2

Secondary malnutrition

Answer 2

accompanies disease which disturbs appetite or food digestion/absorption/utilization

Question 3

Consequences of malnutrition

Answer 3

major cause of death and stunts physical and mental development in developing societies, accompanies wide variety of social, psychiatric, medical and surgical conditions in developed societies

Question 4

Undernutrition

Answer 4

results from a combination of disease and dietary inadequacies -> leads to appetite loss, malabsorption, immunity lowered, mucosal damage, nutrient loss -> can reinforce the primary insults -> leads ultimately to growth faltering and weight loss (primary and secondary malnutrition)

Question 5

Stunting and wasting

Answer 5

low height or weight for age

Question 6

Wasted

Answer 6

has low weight for age but also low weight/height ratio (2 SD below reference)

Question 7

Stunted child

Answer 7

has low weight for age but has NORMAL weight/height ratio and low height/age (2 SD below reference) -> MOST common form (happens around 2nd year of life in developing world -> catch up may OR may not occur -> has severe co-morbidities

Question 8

Stunting

Answer 8

reduces psychosocial development and motor development -> stimulation helps significantly, along with supplements can get this back to normal

Question 9

Long bone growth

Answer 9

Growth and the body composition is controlled mainly at this level -> primary driver of whole body growth, genetic determination of rate/time/extent course (canalization) -> regulated by endocrine and cytokine factors (both are nutritionally regulated and inhibited by infection)

Question 10

Skeletal muscle growth

Answer 10

growth rate and target weight controlled by bone length growth, passive stretch is the physiological stimulus for growth -> muscle activity required for maximum phenotypic mass

Question 11

Visceral organ growth

Answer 11

growth is driven by functional demand -> food intake and metabolic work

Question 12

Endochondrial ossification within the growth plate

Answer 12

stem cells are recruited by GH/IGF-1 -> proliferate, differentiate, undergo apoptosis and mineralization -> nutrition is vital for this process (hormonal activators of chondrogenesis and maturation -> IGF-1 and T3)

Question 13

Infection (cortisol, IL-1, IL-6, TNF)

Answer 13

inhibits chondrogenesis

Question 14

Animal source foods

Answer 14

nutrients that influence height growth -> rich in bioavailable micronutrients and minerals -> milk given to children to increase height

Question 15

Epidemiology

Answer 15

in Denmark milk (NOT MEAT) intake positively associated with sIGF-I and height; Uganda faster height growth in children on milk and meat rather than the children on plantains; in Peru there is a strong association between protein intake and attained height of boys

Question 16

New guinea children

Answer 16

added margarine and the children got fatter but not taller, added extra taro and children got fatter and a bit taller, added milk and children got less fat and taller

Question 17

Protein

Answer 17

strong experimental evidence in animals (slowing and restoration of bone growth in rats), has good INDIRECT data in humans

Question 18

Zinc

Answer 18

good experimental evidence in animals and good META ANALYSIS in humans (supplements increase height not weight for height in children) -> cofactor for a large number of enzymes (proteins can’t function without this nutrient) -> no good stores (hard to see deficiency -> type II nutrient) -> in absence of this nutrient growth stops completely

Question 19

Calcium and phosphate

Answer 19

length growth not thought to be limited by mineral supply in general

Question 20

Infections

Answer 20

frequent low grade -> stunts growth (developed and developing countries) -> MAJOR reason for growth stunting problems

Question 21

Stunting

Answer 21

most likely due to infection and lack of clean water and unsanitary home environments

Question 22

Bowel rest

Answer 22

increases chance of systemic infections -> should give enteral nutrition as much as possible after injury

Question 23

Burns

Answer 23

increased tissue catabolism and energy usage