Childhood Stunting: First 1000 Days and Thereafter
Children need love and nurturing to grow. They also need clean water to drink, sanitation, and nutrients. Macronutrients (fat, protein, and carbohydrates) support metabolism and the proliferation of cells to grow tiny bodies into adolescent and adult forms. Vitamins and minerals are essential co-factors of energy metabolism and required to support cellular structure and function. Without a supply of all these nutrients, growth falters. The right nutrition during the first 1,000 days of life, from the beginning a women’s pregnancy until her child’s 2nd birthday, has an enormous impact on a child’s ability to grow, learn, and rise out of poverty.
Stunting, a failure to achieve one’s full genetic potential for height, can be caused by infections or malnutrition. New research confirms that growth retardation during the first 1,000 days of life has a persisting effect. Using nationally representative data collected on children living in 51 countries, Leroy and colleagues observe that ~70% of the deficit in growth measured in children at 5y of age can be attributed to growth faltering during the first 1,000d. A simple set of growth standards has not been adopted globally to measure development (height and/or weight). Very different interpretations when applying absolute height-for-age differences (HAD) and height-for-age Z scores (HAZ) to assess populations. Absolute HAD seems to be the preferred approach. Leroy and colleagues call for more research on the dynamics and timing of linear growth faltering.
Essential nutrients change health outcomes in those with suboptimal status. The most powerful impact of nutrition interventions and health programs are in the poorest and most disempowered (Black and Hurley, 2014). The 2012 World Health Assembly set a goal of reducing child stunting by 40% by2025. Hidden hunger and malnutrition cannot be solved by any one sector. Government programs will be insufficient because the causes are complex. Multi-sector stakeholders need to engage to find scalable, sustainable solutions (see Scaling Up Nutrition in Practice).
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Leroy JL, Ruel M, Habicht J-P, Frongilla EA. Linear growth deficit continues to accumulate beyond the first 1000 days in low- and middle-income countries : Global evidence from 51 national surveys. 2014 J Nutr doi: 10.3945/jn.114.191981
Black MM, Hurley KM. Investment in early childhood development. 2014 Lancet doi: 10.1016/S0140-6736(14)60607-3