Academic journal article Journal of Health Population and Nutrition

Early-Life Determinants of Stunted Adolescent Girls and Boys in Matlab, Bangladesh

Academic journal article Journal of Health Population and Nutrition

Early-Life Determinants of Stunted Adolescent Girls and Boys in Matlab, Bangladesh

Article excerpt

INTRODUCTION

Heredity determines how tall one can grow, whereas how tall one actually becomes depends partly on nutrition (1). The stature of a mother is probably the best predictor of the height of a child (2-3). The influence from the paternal side seems far less significant (2). Following recommendations of the United Nations Sub-Committee on Nutrition (4), nutritional status should be studied from a life-course (life-cycle) perspective. The (inter- related) effects of early-life growth failure may be passed on from one stage in life to the next via the mechanisms of 'programming' as proposed by Barker (5) and 'cumulative nutritional deprivation'. An inadequate dietary intake in the first years of life results in weight loss, growth faltering, lowered immunity, and mucosal damage, which, in turn, elevates the risks of infectious diseases. In addition, the metabolic system may be further altered. Earlylife growth failure could consequently be passed on to the next generation, resulting in an intergenerational cycle of growth failure. This cycle starts before birth. Low pre-pregnancy nutritional status and insufficient weight gain of the mother during pregnancy are believed to be the main causes of low-birthweight babies (6-7). However, evidence of the relative contribution of genetic inheritance and intrauterine factors on weight and size at birth is inconclusive (8-15), as is the study on its relation to early-life anthropometry and health later in life (5,16-18).

Regarding long-term effects, Cole concluded that the increment in adult height is set by the age of two years, and he suggests that growth at this time in early life is the outcome of an interaction between concurrent nutrition and the growth rate set during pregnancy, reflecting parental size (19). Accordingly, it is believed that, although some height differences between people are attributed to genetics, the general trend for average height to increase is almost certainly due to improvements in nutrition and, to a lesser extent, health (20). Chronic malnutrition and disease in childhood may stunt growth, and potential adult height may not be reached (21). Particularly when children remain in poor environments, the potential for catch-up faltering growth in childhood is believed to be limited after the age of two years (7). There is little evidence that growth retardation suffered in early childhood can be significantly compensated for in adolescence (22). There is, however, evidence, although based on a small-scale (n=60) study, that chronic undernutrition in girls retards skeletal growth and maturation and postpones menarche. However, it does not have an impact on the magnitude of the (adolescent) height spurt, and it also does not result in a lower adult stature because of an extended length of the growth period (23). Also, results of adoption studies showed that some catch-up might be possible due to an extended growing period, but this is not complete for children who remain in an adverse environment (as in Bangladesh), and the effect may be more pronounced for boys than for girls (24-25). Within the context of foetal programming, boys are in general more sensitive to nutritional deprivation than girls (16). Catch-up growth that takes the form of an accelerated growth may also trigger early puberty which limits final height (26).

Within Bangladeshi society, however, during infancy and childhood, the opposite-girls being more vulnerable than boys-may be true as a result of an unequal allocation of food and care at the expense of girls. Although girls survive in greater numbers than infant boys, almost everywhere, in a few countries including Bangladesh, gender discrimination outweighs the biological advantage of girls (22,27-29). Ramifications may be gender differentials in nutritional status and mortality from illness (27,30-33). There are indications that discrimination against girls in Bangladesh is negligible in small families but much more pronounced in families with more than two girls (34). …

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