title: Critical windows for nutritional interventions against stunting.
abstract: An analysis of early growth patterns in children from 54 resource-poor countries in Africa and Southeast Asia shows a rapid falloff in the height-for-age z score during the first 2 y of life and no recovery until ≥5 y of age. This finding has focused attention on the period -9 to 24 mo as a window of opportunity for interventions against stunting and has garnered considerable political backing for investment targeted at the first 1000 d. These important initiatives should not be undermined, but the objective of this study was to counteract the growing impression that interventions outside of this period cannot be effective. We illustrate our arguments using longitudinal data from the Consortium of Health Oriented Research in Transitioning collaboration (Brazil, Guatemala, India, Philippines, and South Africa) and our own cross-sectional and longitudinal growth data from rural Gambia. We show that substantial height catch-up occurs between 24 mo and midchildhood and again between midchildhood and adulthood, even in the absence of any interventions. Longitudinal growth data from rural Gambia also illustrate that an extended pubertal growth phase allows very considerable height recovery, especially in girls during adolescence. In light of the critical importance of maternal stature to her children's health, our arguments are a reminder of the importance of the more comprehensive UNICEF/Sub-Committee on Nutrition Through the Life-Cycle approach. In particular, we argue that adolescence represents an additional window of opportunity during which substantial life cycle and intergenerational effects can be accrued. The regulation of such growth is complex and may be affected by nutritional interventions imposed many years previously.
authors.affiliation: Medical Research Council International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom. andrew.prentice@lshtm.ac.uk
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Prentice
authors.forename: Kate A
authors.initials: KA
authors.lastname: Ward
authors.forename: Gail R
authors.initials: GR
authors.lastname: Goldberg
authors.forename: Landing M
authors.initials: LM
authors.lastname: Jarjou
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Moore
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Fulford
authors.forename: Ann
authors.initials: A
authors.lastname: Prentice
mesh_terms: D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D001827:Body Height; D001835:Body Weight; D001938:Brazil; D049109:Cell Proliferation; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D047109:Fetal Development; D005714:Gambia; D006130:Growth Disorders / Q000503:physiopathology*; D006166:Guatemala; D006801:Humans; D007194:India; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008136:Longevity; D008137:Longitudinal Studies; D008297:Male; D009752:Nutritional Status; D010679:Philippines; D011247:Pregnancy; D012424:Rural Population; D013019:South Africa; D055815:Young Adult
references.citation: Cochrane Database Syst Rev. 2003;(4):CD000032
references.pmid: 14583907
references.citation: Pediatrics. 2001 May;107(5):E75
references.pmid: 11331725
references.citation: Indian J Pediatr. 1991 Jan-Feb;58(1):105-14
references.pmid: 1937614
references.citation: Am J Dis Child. 1982 Apr;136(4):348-52
references.pmid: 6803580
references.citation: Matern Child Nutr. 2008 Apr;4 Suppl 1:24-85
references.pmid: 18289157
references.citation: Acta Paediatr. 2011 Aug;100(8):1113-8
references.pmid: 21366692
references.citation: BMJ. 1997 Sep 27;315(7111):786-90
references.pmid: 9345173
references.citation: Int J Obes Relat Metab Disord. 2003 Feb;27(2):173-80
references.pmid: 12586996
references.citation: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD004736
references.pmid: 19821332
references.citation: Am J Clin Nutr. 1982 Sep;36(3):527-36
references.pmid: 7113957
references.citation: Eur J Clin Nutr. 2000 Jan;54(1):36-40
references.pmid: 10694770
references.citation: BMJ. 2008 Jul 25;337:a605
references.pmid: 18658189
references.citation: Public Health Nutr. 2004 Feb;7(1A):101-21
references.pmid: 14972056
references.citation: Pediatr Res. 2005 Feb;57(2):216-22
references.pmid: 15585685
references.citation: J Nutr. 2004 Jan;134(1):205-10
references.pmid: 14704320
references.citation: Arch Dis Child. 1995 Jul;73(1):17-24
references.pmid: 7639543
references.citation: J Nutr. 2010 Nov;140(11):1996-2001
references.pmid: 20844188
references.citation: Acta Paediatr Suppl. 2006 Apr;450:76-85
references.pmid: 16817681
references.citation: J Health Popul Nutr. 2011 Apr;29(2):134-40
references.pmid: 21608422
references.citation: Food Nutr Bull. 2009 Dec;30(4 Suppl):S533-46
references.pmid: 20120795
references.citation: Pediatrics. 2010 Mar;125(3):e473-80
references.pmid: 20156903
references.citation: Semin Radiat Oncol. 2010 Jan;20(1):12-20
references.pmid: 19959027
references.citation: Eur J Pediatr. 1988 Feb;147(2):188-91
references.pmid: 3366137
references.citation: Am J Hum Biol. 2010 May-Jun;22(3):353-9
references.pmid: 19856426
references.citation: Am J Clin Nutr. 2012 Nov;96(5):1042-50
references.pmid: 22990031
references.citation: Paediatr Perinat Epidemiol. 2012 Jul;26 Suppl 1:302-14
references.pmid: 22742617
references.citation: Am J Clin Nutr. 2005 Jan;81(1):134-9
references.pmid: 15640472
references.citation: Am J Clin Nutr. 2009 Nov;90(5):1372-9
references.pmid: 19793851
references.citation: Lancet. 2009 Sep 19;374(9694):1032-1035
references.pmid: 19766883
references.citation: J Exp Biol. 2010 Jan 1;213(1):3-16
references.pmid: 20008356
references.citation: Eur J Clin Nutr. 1994 Feb;48 Suppl 1:S58-70; discussion S71
references.pmid: 8005092
references.citation: Eur J Clin Nutr. 1994 Feb;48 Suppl 1:S45-57
references.pmid: 8005090
references.citation: Acta Paediatr Scand Suppl. 1989;350:70-94
references.pmid: 2801108
references.citation: Am J Clin Nutr. 2010 Aug;92(2):450-7
references.pmid: 20554790
references.citation: Bull World Health Organ. 1995;73 Suppl:1-98
references.pmid: 8529277
references.citation: Int J Epidemiol. 2012 Jun;41(3):621-6
references.pmid: 21224276
references.citation: Am J Clin Nutr. 2000 Feb;71(2):544-9
references.pmid: 10648270
references.citation: Endocr Rev. 2003 Oct;24(5):668-93
references.pmid: 14570750
references.citation: Am J Hum Biol. 2005 Jul-Aug;17(4):412-7
references.pmid: 15981181
references.citation: Lancet. 1983 Mar 5;1(8323):489-92
references.pmid: 6131208
references.citation: Lancet. 1991 Jul 20;338(8760):131-7
references.pmid: 1677062