Long-lasting effects of undernutrition

Abstract

Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity.

Keywords: body composition; dyslipidaemia; energy expenditure; hypertension; insulin; undernutrition.

Figure 1.

Resting metabolic rate (J/day) (mean7s.d.) over the follow-up time (nonstunted ⋄; stunted ▪). ANOVA: group factor (F (1.20) = 3.04; P = NS), time factor (F (3.60) = 12.7; P < 0.001), and interaction factor (F (3.60) = 4.7; P = 0.005). Reprinted with permission from Eur. J. Clin. Nutr. [45].

Figure 2.

Rate of weight gain/y (mean7s.d.) over the follow-up time (nonstunted ⋄; stunted ▪). ANOVA: group factor (F (1.24) = 0.01; P = NS), time factor (F (2.48) = 3.99; P = 0.02), and interaction factor (F (2.48) = 3.99; P = 0.002). Reprinted with permission from Eur. J. Clin. Nutr. [45].

Figure 3.

Changes in body composition of stunted ( ) and nonstunted children (□) (overall group) between the two study visits. (a) fat mass; (b) lean mass; (c) fat mass percentage; (d) lean mass percentage. The boxes represent the interquartile ranges, which contain 50% of values; the whiskers are the highest and lowest values (excluding outliers), and the line across each box indicates the median. Reprinted with permission from Brit. J. Nutr. [26].

Figure 4.

Correlation between SBP and (A) AngII and (B) ACE activity for girls (open symbols) and boys (solid symbols). The solid lines represent the linear regression and the broken lines are the 95% confidence intervals. Reprinted with permission from Clin. Sci. [67].

Figure 5.

Association between short stature, obesity, hypertension, diabetes and work capacity.