Stunted growth Flashcards
Primary malnutrition
lack of/poor quality food
Secondary malnutrition
accompanies disease which disturbs appetite or food digestion/absorption/utilization
Consequences of malnutrition
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
Undernutrition
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)
Stunting and wasting
low height or weight for age
Wasted
has low weight for age but also low weight/height ratio (2 SD below reference)
Stunted child
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
Stunting
reduces psychosocial development and motor development -> stimulation helps significantly, along with supplements can get this back to normal
Long bone growth
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)
Skeletal muscle growth
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
Visceral organ growth
growth is driven by functional demand -> food intake and metabolic work
Endochondrial ossification within the growth plate
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)
Infection (cortisol, IL-1, IL-6, TNF)
inhibits chondrogenesis
Animal source foods
nutrients that influence height growth -> rich in bioavailable micronutrients and minerals -> milk given to children to increase height
Epidemiology
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
New guinea children
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
Protein
strong experimental evidence in animals (slowing and restoration of bone growth in rats), has good INDIRECT data in humans
Zinc
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
Calcium and phosphate
length growth not thought to be limited by mineral supply in general
Infections
frequent low grade -> stunts growth (developed and developing countries) -> MAJOR reason for growth stunting problems
Stunting
most likely due to infection and lack of clean water and unsanitary home environments
Bowel rest
increases chance of systemic infections -> should give enteral nutrition as much as possible after injury
Burns
increased tissue catabolism and energy usage
