Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Feb 23;14(5):948.
doi: 10.3390/nu14050948.

Understanding Sex Differences in Childhood Undernutrition: A Narrative Review

Susan Thurstans  1 , Charles Opondo  2   3 , Andrew Seal  4 , Jonathan C Wells  5 , Tanya Khara  6 , Carmel Dolan  6 , André Briend  7   8 , Mark Myatt  9 , Michel Garenne  10   11   12   13 , Andrew Mertens  14 , Rebecca Sear  1 , Marko Kerac  1   15
Affiliations
Review

Understanding Sex Differences in Childhood Undernutrition: A Narrative Review

Susan Thurstans et al. Nutrients. .

Abstract

Complementing a recent systematic review and meta-analysis which showed that boys are more likely to be wasted, stunted, and underweight than girls, we conducted a narrative review to explore which early life mechanisms might underlie these sex differences. We addressed different themes, including maternal and newborn characteristics, immunology and endocrinology, evolutionary biology, care practices, and anthropometric indices to explore potential sources of sex differences in child undernutrition. Our review found that the evidence on why sex differences occur is limited but that a complex interaction of social, environmental, and genetic factors likely underlies these differences throughout the life cycle. Despite their bigger size at birth and during infancy, in conditions of food deprivation, boys experience more undernutrition from as early as the foetal period. Differences appear to be more pronounced in more severe presentations of undernutrition and in more socioeconomically deprived contexts. Boys are more vulnerable to infectious disease, and differing immune and endocrine systems appear to explain some of this disadvantage. Limited evidence also suggests that different sociological factors and care practices might exert influence and have the potential to exacerbate or reverse observed differences. Further research is needed to better understand sex differences in undernutrition and the implications of these for child outcomes and prevention and treatment programming.

Keywords: age; sex; undernutrition.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prevalence of stunting in boys and girls by level of food insecurity. Data sources: Country food security scores from the global Food security index, found at https://foodsecurityindex.eiu.com/Index (accessed on 7 September 2021). Stunting prevalence data from the DHS StatCompiler https://www.statcompiler.com/en/ (accessed on 7 September 2021). The right Y-axis relates to the trendline for the male–female difference in prevalence across countries.
See this image and copyright information in PMC

References

    1. Thurstans S., Opondo C., Seal A., Wells J., Khara T., Dolan C., Briend A., Myatt M., Garenne M., Sear R., et al. Boys are more likely to be undernourished than girls: A systematic review and meta-analysis of sex differences in undernutrition. BMJ Glob. Health. 2020;5:e004030. doi: 10.1136/bmjgh-2020-004030. - DOI - PMC - PubMed
    1. Mertens A., Benjamin-Chung J., Colford J.M., Jr., Coyle J., van der Laan M.J., Hubbard E., Dayal S., Malenica I., Hejazi N., Sofrygin O., et al. Causes and consequences of child growth failure in low- and middle-income countries. MedRxiv. 2020 doi: 10.1101/2020.06.09.20127100. - DOI
    1. Khara T., Mwangome M., Ngari M., Dolan C. Children concurrently wasted and stunted: A meta-analysis of prevalence data of children 6–59 months from 84 countries. Matern. Child Nutr. 2017;14:e12516. doi: 10.1111/mcn.12516. - DOI - PMC - PubMed
    1. Obeng-Amoako G.A.O., Sunday Karamagi C.A., Nangendo J., Okiring J., Kiirya Y., Aryeetey R., Mupere E., Myatt M., Briend A., Kalyango J.N., et al. Factors associated with concurrent wasting and stunting among children 6-59 months in Karamoja, Uganda. Matern. Child Nutr. 2020;17:e13074. doi: 10.1111/mcn.13074. - DOI - PMC - PubMed
    1. Myatt M., Khara T., Schoenbuchner S., Pietzsch S., Dolan C., Lelijveld N., Briend A. Children who are both wasted and stunted are also underweight and have a high risk of death: A descriptive epidemiology of multiple anthropometric deficits using data from 51 countries. Arch. Public Health. 2018;76:1–11. doi: 10.1186/s13690-018-0277-1. - DOI - PMC - PubMed