Causes and Mechanisms of Linear Growth Retardation

John C. Waterlow & Bent Schürch, Editors

International Dietary Energy Consultancy Group

Proceedings of an I/D/E/G/C Workshop held in London, U.K.

January 15-18, 1993

On behalf of the UN ACC-Subcommittee on Nutrition, the International Dietary Energy Consultancy Group (I/D/E/C/G) has been established for the study of dietary energy intake in relation to the health and welfare of individuals and societies by the United Nations University. Its specific objectives are:

1. The compilation and interpretation of research data on functional and other consequences of deficiency, change or excess of dietary energy.

2. The identification of related research needs and priorities, and the promotion of needed research.

3. The publication of scientific and policy statements and other information on the significance of chronic deficiencies and excesses of dietary energy.

4. The identification and promotion of appropriate and practical means of corrective action.

I/D/E/C/G Steering Committee:

- Dr. N.S. Scrimshaw, UNU, Chairman
- Dr. J.G.A.J. Hautvast, IUNS
- Dr. B. Schürch, Executive Secretary

I/D/E/C/G Advisory Group (1992/93)

One-year term:

- Dr. W.P.T. James, Aberdeen, Scotland, U.K.
- Dr. E. Pollitt, Davis, USA
- Dr. P. S. Shetty, Bangalore, India

Two-year term:

- Dr. E. Jéquier, Lausanne, Switzerland
- Dr. Jin Soon Ju, Seoul, Korea
- Dr. R. Uauy, Santiago, Chile

Three-year term:

- Dr. L. Allen, Storrs, USA
- Dr. A. Ferro-Luzzi, Rome, Italy
- Dr. R. Martorell, Ithaca, USA

The digitalization of this publication was made possible by a grant from the Nestlé Foundation

Contents

European journal of clinical nutrition

Foreword

Introduction: Causes and mechanisms of linear growth retardation (stunting)

References

Between-population variation in pre-adolescent growth

1. Classifying human populations
2. Population differences in growth patterns
3. The validity of the concept of an international growth reference
References
Discussion

Prenatal influences on postnatal growth: Overview and pointers for needed research

1. Introduction and background
2. Fetal growth
3. Intrauterine growth retardation
4. Small-for-gestational-age infants
5. Genetic and environmental factors
6. Reference values for fetal growth
References
Discussion
References

Linear growth retardation in relation to the three phases of growth

1. Introduction
2. The three phases of linear growth
3. Measuring and monitoring linear growth in early life
4. Growth faltering in linear growth
5. Discussion
References
Discussion

Reversibility of stunting: Epidemiological findings in children from developing countries

1. Introduction
2. The timing of stunting
3. Age at menarche
4. Continued residence in the environment that gave rise to stunting
5. Continued residence in the same environment with improvements in nutrition
6. Relocation from the environment that gave rise to stunting
7. Discussion and conclusions
References

Is complete catch-up possible for stunted malnourished children?'

1. Introduction
2. Duration of the insult
3. What is the height potential?
4. Bone age vs height age
5. Follow-up of malnourished children
6. Change of environment
7. Secondary malnutrition
8. Slave studies
9. Why do most subjects with post-natal stunting fail to catch up?
10. Summary
References
Discussion
References

Relationship of gain in height to gain in weight

References
Discussion
References

Nutritional influences on linear growth: A general review

1. The role of individual nutrient deficiencies in linear growth faltering
2. Dietary quality and linear growth
3. Nutritional explanations of early linear growth faltering
4. The impact of diarrhea, infections and parasites on growth
References

Onset and evolution of stunting in infants and children. Examples from the Human Nutrition Collaborative Research Support Program. Kenya and Egypt studies

1. Introduction
2. The Nutrition Collaborative Research Support Program
3. Example of stunting: Kenya project
4. Example of stunting: Egypt project
5. Summary
References

Effects of macrobiotic diets on linear growth in infants and children until 10 years of age

1. Introduction
2. Subjects and methods
3. Conversion into nutrients
4. Statistical analysis
5. Results
6. Recommendations for the macrobiotic diet
7. Two-year follow-up study
8. Discussion
References
Discussion of papers by Allen, Neumann & Harrison and Dagnelie et al.
Reference

Psychosocial adversity and growth during infancy

1. Introduction
2. Study design and methods
3. Factors determining early and late faltering
4. Conclusions
References
Discussion
Reference

The cell biology of bone growth

1. Introduction
2. The structure and function of bone
3. Skeletal morphogenesis and growth
4. Structure of the growth plate
5. Bone cells
6. Models for the study of skeletal development
7. Regulation of growth plate chondrocytes and bone cells
8. Regulation and mechanisms of cytokine action
Summary
References

Hormonal regulation of longitudinal bone growth

1. Introduction
2. The cellular organization of the epiphyseal growth-plate
3. The effects of hormones and growth factors
4. The effect of nutrition on longitudinal bone growth
5. Summary
References
Discussion of papers by Price et al. and Nilsson et al.
Reference

Adequacy of dietary mineral supply for human bone growth and mineralisation

1. Body content, biological role and childhood accretion rates
2. Likely manifestations of mineral deficiencies in children
3. Dietary intakes of children in developing countries
4. Supplementation studies
Conclusions
References
Discussion

The mechanical factors which influence bone growth

1. Introduction
2. Historical perspective
3. Biomechanics
4. Clinical examples
5. Lengthening
6. Discussion
References

Influence of exercise on linear growth

1. Introduction
2. Studies with weanling rats
3. Studies with children recovering from malnutrition
4. Conclusions
References
Discussion of the papers by Golding and Torun & Viteri

The effects of the inflammatory response on bone growth

1. Systemic changes in inflammation - The acute phase response
2. Local changes in inflammation
3. Mediators of local changes-eicosanoids
4. Mediators of local changes - Cytokines
5. Interleukin-1 (IL-1)
6. Tumour necrosis factor (TNF)
7. Interferon gamma (IFNg)
8. Interactions of osteotropic influences
References
Discussion

Biochemical markers for assessing skeletal growth

1. Introduction
2. Biosynthesis of fibrillar collagens
3. Markers for bone and cartilage turnover
4. Bone resorption markers
5. Bone formation markers
6. Future studies
7. Concluding remarks
References
Discussion
References

Summary of causes and mechanisms of linear growth retardation

Reference

Summary of research needs in the area of linear growth retardation

Guidelines for the study of mechanisms involved in the prevention or reversal of linear growth retardation in developing countries

Introduction
Background
The design of research on stunting
Approaches to the study of stunting
Sample size
Potential experimental models for clinical trials
Examples of useful measurements

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