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Stunted children gain less lean body mass and more fat mass than their non-stunted counterparts: a prospective study

Published online by Cambridge University Press:  09 March 2007

P. A. Martins ,
D. J. Hoffman ,
M. T. B. Fernandes ,
C. R. Nascimento ,
S. B. Roberts ,
R. Sesso  and
A. L. Sawaya
P. A. Martins*
Affiliation:
Department of Physiology, Federal University of São Paulo, Rua Botucatu 862, 2nd andar, Ed. Ciências Biomédicas, São Paulo, CEP 04023-060, Brazil
D. J. Hoffman
Affiliation:
Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
M. T. B. Fernandes
Affiliation:
Department of Physiology, Federal University of São Paulo, Rua Botucatu 862, 2nd andar, Ed. Ciências Biomédicas, São Paulo, CEP 04023-060, Brazil
C. R. Nascimento
Affiliation:
Department of Physiology, Federal University of São Paulo, Rua Botucatu 862, 2nd andar, Ed. Ciências Biomédicas, São Paulo, CEP 04023-060, Brazil
S. B. Roberts
Affiliation:
Energy Metabolism Laboratory, USDA-Human Nutrition Research Center, Tufts University, Boston, MA, USA
R. Sesso
Affiliation:
Department of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
A. L. Sawaya
Affiliation:
Department of Physiology, Federal University of São Paulo, Rua Botucatu 862, 2nd andar, Ed. Ciências Biomédicas, São Paulo, CEP 04023-060, Brazil
*
*Corresponding author: Dr Paula Andrea Martins, fax +55 11 55739525, email, paulamartins@ecb.epm.br
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Abstract

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The aim of the present study was to analyse the changes in body composition of stunted children during a follow-up period and to test the hypothesis of a tendency to accumulate body fat as a consequence of undernutrition early in life. We selected fifty boys and girls aged 11 to 15, who were residents of slums in São Paulo, Brazil. Twenty were stunted (S) and thirty had normal stature (NS). The children's nutritional status and body composition were assessed through anthropometry and dual-energy X-ray absorptiometry, at the beginning of the present study and after 3 years, and changes in lean mass (LM and LM%) and fat mass (FM and FM%) were calculated. Stunted boys accumulated more body fat (FM%: S=1·62%, NS=−3·40%; P=0·003) and gained less lean mass (LM%: S=−1·46, NS=3·21%; P=0·004). Stunted girls gained less lean mass (S=7·87 kg, NS=11·96 kg; P=0·032) and had significantly higher values of FM% at follow-up when compared with their baseline values (P=0·008), whereas non-stunted girls had a non-significant difference in FM% over time (P=0·386). These findings are important to understand the factors involved in the increased prevalence of overweight and obesity among poor populations, which appear to be associated with hunger during infancy and/or childhood.

Keywords

UndernutritionStuntingBody compositionDual-energy X-ray absorptiometry
Type
Research Article
Information
British Journal of Nutrition , Volume 92 , Issue 5 , November 2004 , pp. 819 - 825
Copyright
Copyright © The Nutrition Society 2004

References

Allen, LH & Gillespie, SR (2001) What Works? A Review of the Efficacy and Effectiveness of Nutrition Interventions. Nutrition Policy Paper no. 19 Geneva and Manila ACC/SCN and Asian Development Bank.Google Scholar
Anguita, RM, Sigulem, DM & Sawaya, AL (1993) Intrauterine food restriction is associated with obesity in young rats. J Nutr 123, 1421–1428.Google ScholarPubMed
Ashworth, A (1969) Growth rates in children recovering from protein–calorie malnutrition. Br J Nutr 23, 835–845.CrossRefGoogle ScholarPubMed
Bachrach, LK (2000) Dual-energy X-ray absorptiometry (DEXA) measurements of bone density and body composition: promise and pitfalls. J Pediatr Endocrinol Metab 13, 983–988.Google ScholarPubMed
Benéfice, E, Garnier, D, Simondon, KB & Malina, RM (2001) Relationship between stunting in infancy and growth and fat distribution during adolescence in Senegalese girls. Eur J Clin Nutr 55, 50–58.CrossRefGoogle ScholarPubMed
Brodie, D, Moscrip, V & Hutcheon, R (1998) Body composition measurement: a review of hydrodensitometry, anthropometry, and impedance methods. Nutrition 14, 296–310.CrossRefGoogle ScholarPubMed
Brunton, JA, Bayley, HS & Atkinson, SA (1993) Validation and application of dual-energy x-ray absorptiometry to measure bone mass and body composition in small infants. Am J Clin Nutr 58, 839–845.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (2000) BMI: body mass index. http://www.cdc.gov/nccdphp/dnpa/bmi/index.htm.Google Scholar
Chan, GM (1992) Performance of dual-energy x-ray absorptiometry in evaluating bone, lean body mass, and fat in pediatric studies. J Bone Miner Res 7, 369–374.CrossRefGoogle Scholar
Dulloo, AG & Girardier, L (1993) Adaptive role of energy expenditure in modulating body fat and protein deposition catch-up growth after early undernutrition. Am J Clin Nutr 58, 614–621.CrossRefGoogle ScholarPubMed
Ellis, KJ, Shypailo, RJ, Pratt, JA & Pond, WG (1993) Accuracy of DXA-based body composition measurements for pediatric studies. Basic Life Sci 60, 153–156.Google ScholarPubMed
Faulkner, RA, Bailey, DA, Drinkwater, DT, Wilkinson, AA, Houston, CS & McKay, HA (1993) Regional and total body bone mineral content, bone mineral density, and total body tissue composition in children 8–16 years of age. Calcif Tissue Int 53, 7–12.CrossRefGoogle ScholarPubMed
Fernandes, MTB, Sesso, R, Martins, PA & Sawaya, AL (2003) Increased blood pressure in adolescents of low socioeconomic status with short stature. Pediatr Nephrol 18, 435–439.CrossRefGoogle ScholarPubMed
Ferrannini, E (1992) Equations and assumptions of indirect calorimetry: some special problems. In Energy Metabolism and Tissue Corollaries, pp. 1–17 [Kinney, JM and Tucker, HN, editors]. New York: Raven Press Ltd.Google Scholar
Florêncio, TM, Ferreira, HS, Cavalcante, JC, Luciano, SM & Sawaya, AL (2003) Food consumed does not account for the higher prevalence of obesity among stunted adults in a very-low-income population in the Northeast of Brazil (Maceio, Alagoas). Eur J Clin Nutr 57, 1437–1446.Google Scholar
Florêncio, TT, Ferreira, HS, Cavalcante, JC & Sawaya, AL (2004) Short stature, obesity and arterial hypertension in a very low income population in North-eastern Brazil. Nutr Metab Cardiovasc Dis 14, 26–33.CrossRefGoogle Scholar
Florêncio, TT, Ferreira, HS, De Franca, AP, Cavalcante, JC, Sawaya, AL (2001) Obesity and undernutrition in a very-low-income population in the city of Maceió, northeastern Brazil. Br J Nutr 86, 277–284.CrossRefGoogle Scholar
Fuller, NJ, Wells, JCK & Elia, M (2001) Evaluation of a model for total body protein mass based on dual-energy X-ray absorptiometry comparison with a reference four-component model. Br J Nutr 86, 45–52.CrossRefGoogle Scholar
Gale, CR, Martyn, CN, Kellingray, S, Eastell, R & Cooper, C (2001) Intrauterine programming of adult body composition. J Clin Endocrinol Metab 86, 267–272.Google ScholarPubMed
Going, SB, Massett, MP, Hall, MC, Bare, LA, Root, PA, Williams, DP & Lohman, TG (1993) Detection of small changes in body composition by dual-energy x-ray absorptiometry. Am J Clin Nutr 57, 845–850.CrossRefGoogle ScholarPubMed
Goran, MI (1998) Measurement issues related to studies of childhood obesity: assessment of body composition, body fat distribution, physical activity, and food intake. Pediatrics 101, 505–518.CrossRefGoogle ScholarPubMed
Hediger, ML, Overpeck, MD, Kuczmarski, RJ, McGlynn, A, Maurer, KR & Davis, WW (1998) Muscularity and fatness of infants and young children born small- or large-for-gestational-age. Pediatrics 102, 1–7.CrossRefGoogle ScholarPubMed
Heymsfield, SB, Lichtman, S, Baumgartner, RN, Wang, J, Kamen, Y, Aliprantis, A & Pierson, RN Jr (1990) Body composition of humans: comparison of two improved four-compartment models that differ in expense, technical complexity, and radiation exposure. Am J Clin Nutr 52, 52–58.CrossRefGoogle ScholarPubMed
Hoffman, DJ, Roberts, SB, Verreschi, I, Martins, PA, Nascimento, C, Tucker, K & Sawaya, AL (2000 a) Regulation of energy intake may be impaired in nutritionally stunted children from the shantytowns of São Paulo. Brazil. J Nutr 130, 2265–2270.Google ScholarPubMed
Hoffman, DJ, Sawaya, AL, Coward, WA, Wright, A, Martins, PA, de Nascimento, C, Tucker, KL & Roberts, SB (2000 b) Energy expenditure of stunted and nonstunted boys and girls living in the shantytowns of Sao Paulo. Brazil. Am J Clin Nutr 72, 1025–1031.CrossRefGoogle ScholarPubMed
Hoffman, DJ, Sawaya, AL, Verreschi, I, Tucker, K & Roberts, SB (2000 c) Why are nutritionally stunted children at increased risk of obesity? Studies of metabolic rate and fat oxidation in shantytown children from São Paulo. Brazil. Am J Clin Nutr 72, 702–707.CrossRefGoogle ScholarPubMed
Kahn, HS, Narayan, KM, Williamson, DF & Valdez, R (2000) Relation of birth weight to lean and fat thigh tissue in young men. Int J Obes Relat Metab Disord 24, 667–672.Google Scholar
Kooh, SW, Noriega, E, Leslie, K, Muller, C & Harrison, J (1993) Bone mass and soft tissue compartments in adolescents with anorexia nervosa. Basic Life Sci 60, 173–176.Google ScholarPubMed
Kyle, UG, Genton, L, Hans, D, Karsegard, JPM, Slosman, DO & Pichard, C (2001) Total body mass, fat mass, fat-free mass, and skeletal muscle: cross-sectional differences in 60-year-old persons. J Am Geriatr Soc 49, 1633–1640.Google ScholarPubMed
Litaker, MS, Barbeau, P, Humphries, MC & Gutin, B (2003) Comparison of Hologic QDR-1000/W and 4500W scanners in 13 to 18-year olds. Obes Res 12, 1545–1552.CrossRefGoogle Scholar
Lohman, TG, Harris, M, Teixeira, PJ & Weiss, L (2000) Assessing body composition and changes in body composition. Another look at dual-energy X-ray absorptiometry. Ann N Y Acad Sci 904, 45–54.CrossRefGoogle Scholar
Malina, RM & Bouchard, C (1988) Subcutaneous fat distribution during growth. In Fat Distribution During Growth and Later Health Outcomes, pp. 63–84 [Bouchard, C and Johnston, FE, editors]. New York: Alan R. Liss.Google Scholar
Phillips, DI (1996) Relation of fetal growth to adult muscle mass and glucose tolerance. Diabet Med 12, 686–690.CrossRefGoogle Scholar
Rico, H, Revilla, M, Villa, LF, Hernandez, ER, Alvarez, de, Buergo, M & Villa, M (1993) Body composition in children and Tanner's stages: a study with dual-energy x-ray absorptiometry. Metabolism 42, 967–970.CrossRefGoogle ScholarPubMed
Sawaya, AL, Grillo, LP, Verreschi, I, Silva, AC & Roberts, SB (1998) Mild stunting is associated with higher susceptibility to the effects of high fat diets: studies in a shantytown population in São Paulo, Brazil. J Nutr 128, 415–420.CrossRefGoogle Scholar
Schroeder, DG, Martorell, R & Flores, R (1999) Infant and child growth and fatness and fat distribution in Guatemalan adults. Am J Epidemiol 49, 177–185.CrossRefGoogle Scholar
Shetty, PS (1999) Adaptation to low energy intakes: the responses and limits to low intakes in infants, children and adults. Eur J Clin Nutr 53, 14–33.CrossRefGoogle ScholarPubMed
Sichieri, R, Siqueira, KS & Moura, AS (2000 a) Obesity and abdominal fatness associated with undernutrition early in life in a survey in Rio de Janeiro. Int J Obes Relat Metab Disord 24, 614–618.Google Scholar
Sichieri, R, Siqueira, KS, Pereira, RA & Ascherio, A (2000 b) Short stature and hypertension in the city of Rio de Janeiro, Brazil. Public Health Nutr 3, 77–82.CrossRefGoogle ScholarPubMed
Skinner, JD, Bounds, W, Carruth, BR & Ziegler, P (2003) Longitudinal calcium intake is negatively related to children's body fat indexes. Am J Diet Assoc 103, 1626–1631.Google Scholar
Tanner, JM (1962) The development of the reproductive system. In Growth at Adolescence, 2nd ed. Oxford: Blackwell Scientific Publications..Google Scholar
Tylavsky, FA, Lohman, TG, Dockrell, M, Lang, T, Schoeller, DA, Wan, JY, Fuerst, T, Cauley, JA, Nevitt, M & Harris, TB (2003) Comparison of the effectiveness of 2 dual-energy X-ray absorptiometers with that of total body water and computed tomography in assessing changes in body composition during weight change. Am J Clin Nutr 77, 356–363.Google Scholar
Velasquez-Melendez, G, Martins, IS, Cervato, AM, Fornés, NS, Marucci, MFN & Coelho, LT (1999) Relationship between stature, overweight and central obesity in the adult population in São Paulo, Brazil. Int J Obes 23, 639–644.CrossRefGoogle ScholarPubMed
Venkataraman, PS & Ahluwalia, BW (1992) Total bone mineral and body composition by x-ray densitometry in newborns. Pediatrics 90, 767–770.CrossRefGoogle ScholarPubMed
Walker, SP, Gaskin, PS, Powell, CA & Bennett, FI (2002) The effects of birth weight and postnatal linear growth retardation on body mass index, fatness and fat distribution in mid and late childhood. Public Health Nutr 5, 391–396.CrossRefGoogle ScholarPubMed
Waterlow, JC (1999) The nature and significance of nutritional adaptation. Eur J Clin Nutr 53, 2–5.CrossRefGoogle ScholarPubMed
Wong, WW, Hergenroeder, AC, Stuff, JE, Butte, NF, Smith, EO & Ellis, KJ (2002) Evaluating body fat in girls and female adolescents: advantages and disadvantages of dual-energy X-ray absorptiometry. Am J Clin Nutr 76, 384–389.CrossRefGoogle ScholarPubMed
World Health Organization (1995) Physical Status: the Use and Interpretation of Anthropometry. Technical Report Series no. 854 Geneva: World Health Organization.Google Scholar