title: Association between chronic undernutrition and hypertension.
abstract: In developing countries nutritional deficit during prenatal and continuing in post-natal life is very common. This condition leads to stunting and important metabolic changes. Over 30% of children in the world are stunted. The metabolic resultants of nutritional deficit during growth are classically known to aim at energy conservation. This review summarizes data from Brazil, a developing country undergoing the double burden of obesity and undernutrition, especially among the poor, and suggests that stunting or chronic undernutrition increases the risk of obesity and hypertension later in life. Around 60 million people are under the poverty line in Brazil. In São Paulo, the richest city of the country, 20% of the population live in slums and in Maceió, the capital of one of the poorest states, this percentage reaches 50%. Undernutrition in this population is around 20% among children, with high frequency of infections, anemia, and parasitic infestations, associated with poor sanitation. Among stunted adolescents, we found a high prevalence of hypertension (21%) that is a considerably higher estimate compared to non-stunted adolescents (less than 10%). The prevalence of hypertension in undernourished pre-school children, or in those who recovered from undernutrition, was higher than that in controls (29%, 20% and 2%, respectively, P < 0.001). Among stunted adults eating no more than 66% of the requirements (adjusted for stature), overweight/obesity was 35% in women and 25% in men. The prevalence of hypertension was 44% among stunted women and 18% among stunted men. Fifty per cent of stunted and obese women had hypertension. These data reinforce the important association between undernutrition and hypertension from childhood through adulthood. Health policies for preventing and combating childhood undernutrition should have an impact on the morbidity and mortality related to hypertension during adulthood.
authors.affiliation: Department of Physiology, Universidade Federal de São Paulo, Rua Botucatu 862, 2o andar, São Paulo, SP, Brazil. anafisi@ecb.epm.br
authors.forename: Ana L
authors.initials: AL
authors.lastname: Sawaya
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sesso
authors.forename: Telma M de Menezes Toledo
authors.initials: TM
authors.lastname: Florêncio
authors.forename: Maria T B
authors.initials: MT
authors.lastname: Fernandes
authors.forename: Paula A
authors.initials: PA
authors.lastname: Martins
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D002908:Chronic Disease; D003906:Developing Countries; D005260:Female; D006128:Growth / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009748:Nutrition Disorders / Q000453:epidemiology / Q000503:physiopathology*; D009765:Obesity / Q000150:complications* / Q000453:epidemiology*; D011203:Poverty