Understanding Sex Differences in Childhood Undernutrition: A Narrative Review
Susan Thurstans1, Charles Opondo2,3, Andrew Seal4
1Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Insights
Boys face higher risks of undernutrition, including wasting and stunting, from early life due to a complex interplay of biological and social factors. This vulnerability is more pronounced in severe cases and disadvantaged settings, requiring further research for targeted interventions.
Area of Science:
- Child Health
- Nutritional Science
- Sex Differences in Health
Background:
- Recent meta-analysis indicates boys are more prone to undernutrition (wasting, stunting, underweight) than girls.
- Early life factors influencing these sex-based disparities require further investigation.
Purpose of the Study:
- To conduct a narrative review exploring early life mechanisms behind sex differences in child undernutrition.
- To examine maternal, newborn, immunological, endocrinological, evolutionary, and care practice factors.
Main Methods:
- Narrative review of existing literature.
- Exploration of themes including maternal and newborn characteristics, immunology, endocrinology, evolutionary biology, care practices, and anthropometric indices.
Main Results:
- Evidence is limited, but a complex interaction of social, environmental, and genetic factors likely underlies sex differences in undernutrition.
- Boys exhibit greater undernutrition from the fetal period, especially during food deprivation, with differences amplified in severe cases and deprived contexts.
- Boys' higher vulnerability to infectious disease and differing immune/endocrine systems contribute to undernutrition risk. Sociological factors and care practices may also play a role.
Conclusions:
- Sex differences in child undernutrition are multifactorial, involving biological, social, and environmental influences.
- Boys' increased susceptibility to infectious diseases and distinct immune/endocrine profiles are key factors.
- Further research is crucial to understand these differences and inform prevention and treatment strategies for child undernutrition.
Abstract:
Complementing a recent systematic review and meta-analysis which showed that boys are more likely to be wasted, stunted, and underweight than girls, we conducted a narrative review to explore which early life mechanisms might underlie these sex differences. We addressed different themes, including maternal and newborn characteristics, immunology and endocrinology, evolutionary biology, care practices, and anthropometric indices to explore potential sources of sex differences in child undernutrition. Our review found that the evidence on why sex differences occur is limited but that a complex interaction of social, environmental, and genetic factors likely underlies these differences throughout the life cycle. Despite their bigger size at birth and during infancy, in conditions of food deprivation, boys experience more undernutrition from as early as the foetal period. Differences appear to be more pronounced in more severe presentations of undernutrition and in more socioeconomically deprived contexts. Boys are more vulnerable to infectious disease, and differing immune and endocrine systems appear to explain some of this disadvantage. Limited evidence also suggests that different sociological factors and care practices might exert influence and have the potential to exacerbate or reverse observed differences. Further research is needed to better understand sex differences in undernutrition and the implications of these for child outcomes and prevention and treatment programming.
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