Factors in stunted growth
Infections due to poor water quality may be the cause of short stature.
REDUCING child mortality rates was one of the goals established by the United Nations (UN) in the year 2000, through the Millennium Goals. Indeed, much progress has been made in the last two decades around the world.
“Children are surviving more, both in developed and developing nations. But much of it is not thriving as it could and can not reach its potential for cognitive and physical development. And that has tremendous implications for countries,” said researcher Helen Raikes of the College of Education and Humanities at the University of Nebraska-Lincoln in the United States.
In a speech presented at FAPESP Week Nebraska-Texas recently, Raikes spoke about how the lack of basic sanitation and access to quality drinking water could be at the root of problems such as short stature and other conditions associated with malnutrition.
“The relationship between the frequent occurrence of diarrhoea and infant mortality is well established. However, recent studies have shown that repeated bacterial infections can also affect intestinal villi and microbiota profile – impairing the absorption of nutrients for the rest of the life,” said the researcher.
When the problem occurs in periods of high vulnerability, such as the first two years of life, the damage can be final.
According to Raikes, three areas are particularly impaired: cognitive development, stature and intestinal microbioma (strongly related to metabolic health and immunity).
Such a condition creates great disparities in the development of children from different socioeconomic contexts and causes loss of human potential,” said the researcher.
As Raikes commented, neuroscience has shown that the experiences that an individual experiences in the early years of life are incorporated into the organism and lay the foundation for future experiences. A developmental period, said the researcher, is built on the previous one.
The importance of the first thousand days of life for children’s development was also discussed during a lecture by Marly Augusto Cardoso, a professor at the School of Public Health (FSP) at the University of São Paulo (USP).
She presented the results of a survey carried out over a 10-year period (2003-2012) in the municipality of Acrelândia (AC) with about 1,000 children under 10 years.
“What draws attention in this region to the national scenario is that child malnutrition – and consequently the height deficit and the prevalence of anaemia – has not diminished as strongly as in other Brazilian states. Acre still has very precarious child health indicators. The occurrence of diarrhea in young children, for example, is much more frequent than in other regions,” Cardoso said.
At the same time, said the researcher, it is possible to observe an excessive weight gain in school children – possibly caused by the substitution of the traditional food standard for the modern, composed mainly of industrialised products.
“This is a two-fold scenario of diseases related to nutritional status: there are still not completely remedied deficiencies and, at the same time, risk of excessive weight gain that predisposes to cardiovascular and metabolic diseases in adulthood,” he commented.
The research in Acrelândia was done with the support of FAPESP during the doctorate of Barbara Hatzlhoffer Lourenço.
Currently, Cardoso coordinates a thematic project that intends to identify in the municipality of Cruzeiro do Sul – Acre’s second most populous region and an endemic region for malaria – factors that can promote both health promotion in school life and adolescence and the reduction of risk factors in adult life.
The population-based study, which began in 2015, intends to follow the determinants of maternal and child health from gestation and delivery until the end of the second year of life.
About 1,500 families are participating in the city’s only maternity ward, thanks to the partnership with agents of the Family Health Program (PSF). Teachers and students of the Federal University of Acre (UFAC) also collaborate with the study.
“The project has many facets. We will investigate nutritional deficiencies in mothers and children, risk of malaria and dengue infection, early weight gain, and mothers’ eating practices.
“We also intend to study the intestinal microbiota of the volunteers and do epigenetic analyses (to understand how environmen- tal factors are modulating gene expression),” Cardoso said.
A pilot study of 500 pregnant women from the same municipality showed that 19% of them are adolescents – an index higher than the national average.
On the other hand, 24% were overweight, 18.7% did not gain sufficient weight during pregnancy, and 59%, on the other hand, gained excess weight in the period (although they were not necessarily above the average considered ideal when they were evaluated).
The anaemia index in the third trimester was 17.5% and 13.4% had vitamin A deficiency.
“One thing we have already noted is that gestational malaria is a neglected problem and we know it may be one of the causes of low birth weight,” he said.
Also during the programme, Susan Sheridan, director of the Nebraska Center for Research on Children, Youth, Families and Schools, presented a series of studies aimed at promoting family mental health and, child development.
According to Sheridan, a collaborative work done by researchers from Brazil and Nebraska found that when parents have a solid relationship, children do better.
This research line currently seeks to identify interventions that improve family relationships, such as teletherapy. – Agência FAPESP