Linear Growth Retardation in Less Developed Countries

Abstract

The reason for organizing this workshop is very simple. If we use a low weight for age as the basis for the anthropometric diagnosis of malnutrition, then in many countries some four-fifths of the children considered to be malnourished are simply small in size, with normal weight for height (Table 1). However, it is remarkable that there has been no systematic attempt to tackle the question: Is it meaningful or realistic to call these small children malnourished? To establish a valid definition , we must avoid a circular argument: nutritional status is assessed by measurement of body size; therefore, a small child is malnourished. The question posed above is of great public health importance, and attempts to answer it will bring us into difficult territory. It may be useful to divide the question into two parts. First, does smallness imply any impairment of health or functional capacity? More precisely, what are the relationships between body size and different functions after interfering factors have been removed (if, indeed, they can be removed)? Here we are dealing with the mal in malnutrition. The second part of the question is whether the effects are caused primarily by nutritional factors and, if they are, by what mechanism? The chapters in this volume are addressed to different aspects of these two questions. These in turn encompass a third question: Does stunting represent a situation that calls for action in countries where resources are scarce, and, if so, what kind of action? TABLE 1. Prevalence of malnutrition (percentage) in preschool children according to different criteria' Vietnam Criterion of malnutrition Nepal Sri Lanka refugees Wasted, stunted, or wasted and stunted 56.2 37.1 65.7 Wasted or wasted and stunted (excluding children who are stunted only) 7.3 6.6 10.8 •Cut-off points: wasted, <80% of reference median; Stunted, <90% of reference median.