Postnatal origins of undernutrition.

Obesity and nutrition-related chronic disorders are fast rising in developing countries. But undernutrition--stunting, underweight, wasting and micronutrient deficiencies--still affect millions of preschool children in both rural and urban settings increasing the risks of morbidity and mortality, impairing cognitive development, reducing productivity and increasing the risk of chronic diseases in later life. In addition undernutrition has a transgenerational effect. Here I review the evidence for a synergistic effect of inadequate nutrition (breastfeeding, complementary feeding), infection, and inappropriate mother-child interactions on growth and nutritional deficiencies. Underlying socioeconomic, environmental and genetic factors are also explored. Finally some perspectives on how urbanization and globalization may affect the prevalence and distribution of undernutrition are discussed. Fighting child under-nutrition is still an urgent necessity and a moral imperative.

Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants.

BACKGROUND: The World Health Organization (WHO) released new Child Growth Standards in 2006 to replace the current National Center for Health Statistics (NCHS) growth reference. We assessed how switching from the NCHS to the newly released WHO Growth Standards affects the estimated prevalence of wasting, underweight and stunting, and the pattern of risk factors identified. METHODOLOGY/PRINCIPAL FINDINGS: Data were drawn from a village-informant driven Demographic Surveillance System in Northern Malawi. Children (n = 1328) were visited twice at 0-4 months and 11-15 months. Data were collected on the demographic and socio-economic environment of the child, health history, maternal and child anthropometry and child feeding practices. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. In early infancy, prevalence estimates were 2.9, 6.1, and 8.5 fold higher for stunting, underweight, and wasting respectively using the WHO standards compared to NCHS reference (p<0.001 for all). At one year, prevalence estimates for wasting and stunting did not differ significantly according to reference used, but the prevalence of underweight was half that with the NCHS reference (p<0.001). Patterns of risk factors were similar with the two growth references for all outcomes at one year although the strength of association was higher with WHO standards. CONCLUSIONS/SIGNIFICANCE: Differences in prevalence estimates differed in magnitude but not direction from previous studies. The scale of these differences depends on the population's nutritional status thus it should not be assumed a priori. The increase in estimated prevalence of wasting in early infancy has implications for feeding programs targeting lactating mothers and ante-natal multiple micronutrients supplementation to tackle small birth size. Risk factors identified using WHO standards remain comparable with findings based on the NCHS reference in similar settings. Further research should aim to identify whether the young infants additionally diagnosed as malnourished by this new standard are more appropriate targets for interventions than those identified with the NCHS reference.