Understanding Growth Trajectories
The highest growth rates in weight and length occur during fetal life and in the first two years of life after birth and during adolescence. However, children’s growth curves vary greatly due to the complexity of factors associated with their behavior, which encompasses not only endogenous factors, including biological, genetic, and ethnic determinants, but also exogenous factors, such as nutritional, cultural, environmental, and social factors. Growth must be monitored from birth to the end of adolescence making early diagnosis of any nutritional risk possible and leading to early intervention when necessary and better outcomes in adult age.
Key messages:
• In times of social and economic crisis, which further aggravate the chaotic situation worldwide, the loss of income, the inequalities, the incapacity of the public systems to guarantee minimum aspects of defense, have uncontrollably increased food insecurity.
• Malnutrition has many faces around the world, and we all need to cope with multiple burden of undernutrition, micronutrient deficiencies, stunting and excess weight in the same population.
• Growth must be monitored from birth to the end of adolescence, with routine measurement of weight, height, circumferences, and perimeters. Growth velocity must be verified frequently, and graphic plotting is mandatory.
• Early diagnosis of any nutritional risk leads to early intervention and better outcomes in adult age.
• Human growth is a continuous process, with specificities in the different phases of life and is influenced by different factors, both exogenous and endogenous.
The highest growth rates in weight and length occur during fetal life and in the first two years of life after birth and during adolescence. However, children’s growth curves vary greatly due to the complexity of factors associated with their behavior, which encompasses not only endogenous factors, including biological, genetic, and ethnic determinants, but also exogenous factors, such as nutritional, cultural, environmental, and social factors.1-2
Growth must be evaluated in context of gestational age, with continuous vigilance of weight gain and fetus measurement with possible toolsclinical examination in prenatal care and all physical methods as ultrasound. From birth, weight, height, and circumferences are necessary tools to evaluate adequate growth and children must not only be measured2, but data must be interpreted to understand the possible need for precocious intervention and nutritional guidance. Not all nutritional consequences are at our range of action, but education and access to information is mandatory. Epidemic crisis as Ebola, Sars Covid 19 infection and climate and political processes, lead to hunger with nutritional acute and long-term consequences.
The reflection in the pediatric population is that we still have malnourished children at high risk for diseases related to nutritional deficiencies, infectious diseases, and even death today. We all live with an increase in chronic, non-transmissible diseases, such as overweight, which already affects more than 4 in every ten children in different countries, as well as abnormalities like hypertension, and metabolism abnormalities. At the same time, we still face hunger and malnutrition, and also short stature as a consequence of generations suffering from lack of food, and deficiency of micronutrients such as iron, calcium, and some vitamins. The usual names of micronutrient deficits are not always related to hunger or malnutrition. They do present clinical issues that are independent from nutritional status and are quite prevalent in humans. Hidden hunger or silent malnutrition are best named as micronutrient deficiencies. One example is the huge prevalence of nutritional anemia around the world.
The prevalence of childhood obesity has increased rapidly worldwide in recent years.
Childhood obesity prevalence data indicate that almost 15% of them present excess weight (overweight and obesity). In Latin American and Caribbean countries, about 10-15% of children up to 4 years of age are overweight, with data like countries such as the United States and Canada; this prevalence tends to be somewhat higher among boys compared to girls. For overweight, the prevalence for both sexes show a similar trend to obesity. Addressing the epidemic of obesity in children will require integration of multiple sectors to ensure adequate access to economic resources, education, health, food environment, and universal health coverage.3-4
Evaluating the other side of the spectrum, long-term malnutrition results or diminished weight gain and delays in growth rate, the so-called nutritional stunting. For nutritional recovery or catch-up growth, all nutrients must be considered, at an adequate rate to avoid overweight and recurrent nutritional loss.5
New nutrients other than protein have been evaluated in nutritional recovery as synergistic factors for growth, development, appetite, and bone plate modifications resulting in healthy growth.
Intervention strategies require, however, stronger political, economic and health multidisciplinary approaches.6
References
1. Fisberg M, Duarte Batista L, Nogueira de Almeida CA, de Albuquerque MP, Sarti FM e Fisberg RM- Integrative Strategies for Preventing Nutritional Problems in the Development of children in Brazil- PERSPECTIVE article. Front. Nutr., 13 August 2021 | https://doi.org/10.3389/ fnut.2021.662817
2. de Onis M. (2017) Child Growth and Development. In: de Pee S., Taren D., Bloem M. (eds) Nutrition and Health in a Developing World. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-31943739-2_6
3. Drummond MF, O’Brien B, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes, 4th. Edn. New York, NY: Oxford University Press (2015).
4. Cradock AL, Barrett JL, Kenney EL, Giles CM, Ward ZJ, Long MW, et al. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Prev Med. (2017) 95:S17–27. doi: 10.1016/j. ypmed.2016.10.017
5. Fisberg M.; Duarte Batista L. Nutrition Related Practices in Brazilian Preschoolers: identifying challenges and addressing barriers. In Black MM, Singhal A, Hillman CH (eds): Building Future Health and Well-Being of Thriving Toddlers and Young Children. Nestlé Nutr Inst Workshop Ser. Basel, Karger, 2020, vol 95, pp 23–32 https://doi. org/10.1159/000511509
6. Haines J, Haycraft E, Lytle L, Nicklaus S, Kok FJ, Merdji M, Fisberg M, Moreno LA, Goulet O, Hughes SO. Nurturing Children’s Healthy Eating: Position statement. Appetite. 2019 Jun 1;137:124-133. doi: 10.1016/j.appet.2019.02.007. Epub 2019 Feb 21. PMID: 30797837.
