Growth in transitional countries: The long-term impact of under-nutrition on health

Context: Despite significant economic development in many parts of the world, upwards of 150 million children are short for their age. Epidemiologic and clinical data suggest that stunting increases the risk for nutrition-related chronic diseases (NRCD), a particular problem for transitional countries as dietary and environmental shifts that accompany development are also reported to increase the risk for NRCD. Objective and methods: This paper reviews studies on the causes and long-term effects of poor nutrition as well as data from clinical studies of growth retardation and metabolism and body composition that may explain the link between poor growth and later risk for NRCD. Results: Growth retardation is the physical outcome of a complex interaction of socio-economic factors during key periods of development. Growth-retarded children may present with metabolic or body fat distribution profiles that predispose them to NRCD, a risk factor that may be compounded by consuming a diet consistent with the 'nutrition transition'. Conclusion: It is important to continue studying the long-term physiological changes following recovery from undernutrition, especially in countries undergoing a 'nutrition transition'. Estimates suggest that, within 20-30 years, similar to 2/3 of the world population will reside in urban areas. The potential economic fallout of continued poor nutrition, poor growth and changing diets and activity patterns will be great given the healthcare costs and social problems associated with NRCD.