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Physical growth and bone age of survivors of protein energy malnutrition
Insights
Severe early protein energy malnutrition (PEM) stunts growth in children, particularly girls, even after rehabilitation. Prenatal and genetic factors likely contribute to long-term short stature in affected children.
Area of Science:
- Pediatrics
- Nutrition Science
- Developmental Biology
Background:
- Early postnatal malnutrition, particularly protein energy malnutrition (PEM), is prevalent in low socioeconomic populations.
- Undernutrition during early childhood significantly impacts growth and developmental trajectories.
- Children from lower socioeconomic backgrounds often exhibit shorter stature compared to their higher socioeconomic counterparts.
Purpose of the Study:
- To investigate the long-term effects of severe, early-onset protein energy malnutrition on physical growth and bone maturation in preschool children.
- To compare growth and bone development in rehabilitated PEM children with a control group from a similar socioeconomic background.
Main Methods:
- Longitudinal growth measurements over 4-6 years for 40 children with a history of infant PEM and 38 controls.
- Bone age assessment using wrist roentgenograms in a subgroup of participants.
- Statistical analysis correlating PEM, birth weight, maternal height, head circumference, and growth parameters.
Main Results:
- Children with a history of PEM showed significantly delayed stature, especially girls (p < 0.001), persisting for over four years.
- Weight-to-height ratio was reduced in boys with PEM compared to controls.
- Both groups exhibited delayed bone maturation, with no significant inter-group differences; bone age correlated positively with arm fat area (controls) and height-for-age (PEM boys).
Conclusions:
- Severe early protein energy malnutrition leads to lasting growth deficits, particularly in height, even after nutritional rehabilitation.
- The similar bone age between rehabilitated children and controls, despite height differences, suggests significant contributions of genetic or prenatal factors to impaired growth.
- Maternal size and infant birth size are correlated with PEM and may indicate underlying genetic predispositions to reduced growth potential.
Abstract:
Early postnatal malnutrition produces delay in growth and developmental processes, and children from a low socioeconomical level where undernutrition is prevalent are shorter than those from higher socioeconomic levels. We examined the effects of severe and early protein energy malnutrition on growth and bone maturation. We studied 40 preschool children who had been admitted to hospital in infancy with protein energy malnutrition and 38 children from the same socioeconomic level, paired for age and sex, who had never been malnourished. Growth measurements were made over a period of 4-6 years, and bone age was determined in a subgroup through wrist roentgenograms. Results showed a correlation between protein energy malnutrition, birth weight of infants, and mother's height and head circumference. The group with protein energy malnutrition showed a significant delay in stature after four years, especially the girls (p less than 0.001). Weight:height ratio was reduced in boys compared with controls but not in girls. Both groups showed a delay in bone maturation, but there were no significant differences between them. We found a positive correlation between bone age and arm fat area in control boys and between bone age and height for age in boys with protein energy malnutrition. The finding that rehabilitated children were shorter than the control group but had similar bone age at follow up suggests that genetic or prenatal factors were important in their later poor growth, and this suggestion is supported by their smaller birth size and the smaller size of their mothers.