Long-term consequences of stunting in early life

Abstract

This review summarizes the impact of stunting, highlights recent research findings, discusses policy and programme implications and identifies research priorities. There is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life. Recent research findings, including follow-up of an intervention trial in Guatemala, indicate that stunting can have long-term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes. This evidence has contributed to the growing scientific consensus that tackling childhood stunting is a high priority for reducing the global burden of disease and for fostering economic development. Follow-up of randomized intervention trials is needed in other regions to add to the findings of the Guatemala trial. Further research is also needed to: understand the pathways by which prevention of stunting can have long-term effects; identify the pathways through which the non-genetic transmission of nutritional effects is mediated in future generations; and determine the impact of interventions focused on linear growth in early life on chronic disease risk in adulthood.

Figure 1

Timing of growth faltering: mean height‐for‐age z‐scores by age for 54 studies, relative to the WHO standard. WHO Regional Office for Europe (EURO); WHO Regional Office for the Eastern Mediterranean (EMRO); WHO Regional Office for Africa (AFRO); Pan American Health Organization (PAHO); WHO Regional Office for South‐East Asia (SEARO). Source: Victora et al., reproduced with permission from Pediatrics 125, e473–e480. Copyright 2010 by the AAP. AAP, American Academy of Pediatrics; WHO, World Health Organization.

Figure 2

Percentage of women aged 15–49 with anaemia, DHS 2003–2009. Anaemia cut‐offs, non‐pregnant women: any, <12.0 g dL⁻¹; mild, 10.0–11.9 g dL⁻¹; moderate, 7.0–9.9 g dL⁻¹; and severe, <7.0 g dL⁻¹ and pregnant women: any, <11.0 g dL⁻¹; mild, 10.0–10.9 g dL⁻¹; moderate, 7.0–9.99 g dL⁻¹; and severe, <7.0 g dL⁻¹. DHS, Demographic and Health Surveys.

Figure 3

Potential causal pathways for long‐term consequences of stunting (Source: adapted from Grantham‐McGregor et al. 2007).

Figure 4

Prospective cohort studies nested in the follow‐up of the Institute of Nutrition of Central America and Panama trial (Source: adapted from Ramirez‐Zea et al. 2010).