Low intake of calcium and vitamin D, but not zinc, iron or vitamin A, is associated with stunting in 2- to 5-year-old children.
OBJECTIVE
This cross-sectional study examined the nutritional factors associated with the high levels of stunting in 2- to 5-y-old children in an impoverished South African setting where liver is frequently eaten and vitamin A deficiency known to be absent.


METHODS
Children's dietary intake was assessed by a single 24-h recall. Heights and weights were measured and information was obtained on breast-feeding history, the child's habitual milk intake, as well as substance use by the mother during pregnancy (n = 150).


RESULTS
The overall prevalence of stunting was 36.9% (CI 29.2, 44.6) and increased with age, being 49% in the 4- to 5-y-old age category. Birth weight correlated significantly with height-for-age z-scores (HAZ; r = 0.250, P = 0.003), and was lower in children whose mothers smoked and used alcohol during pregnancy than in children whose mothers abstained (P < 0.0001). Median intake of energy, carbohydrate and protein was adequate. Median intake for all micronutrients was at least 90% of the estimated average requirement, except for calcium, vitamin D and vitamin E, which was 21%, 15%, and 32%, respectively. Intake of fat, calcium, phosphorous, vitamin D, riboflavin, and vitamin B12 (nutrients that typically occur in milk) was significantly lower in stunted than in non-stunted children (P < 0.05). When excluding children with low birth weight, intake of calcium, vitamin D, and riboflavin were still significantly lower (P < 0.05). HAZ was higher in children who habitually drank milk compared to those who did not (P = 0.003).


CONCLUSIONS
Inadequate calcium and vitamin D intake, presumably because of low intake of milk after weaning, may have contributed to stunting in this population.
Nutritional Intervention Research Unit, South African Medical Research Council, Cape Town, South Africa; Currently Non-communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa. Electronic address: Lize.van.stuijvenberg@mrc.ac.za.
Martha E
ME
van Stuijvenberg
Integrated Nutrition Programme, Department of Health, Northern Cape, South Africa.
Jana
J
Nel
Nutritional Intervention Research Unit, South African Medical Research Council, Cape Town, South Africa.
Serina E
SE
Schoeman
Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.
Carl J
CJ
Lombard
Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Lisanne M
LM
du Plessis
Nutritional Intervention Research Unit, South African Medical Research Council, Cape Town, South Africa; Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Muhammad A
MA
Dhansay
D000818:Animals; D001724:Birth Weight; D002118:Calcium / Q000008:administration & dosage / Q000172:deficiency*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D000090463:Iron Deficiencies; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage / Q000172:deficiency*; D009752:Nutritional Status; D011247:Pregnancy; D011248:Pregnancy Complications; D015995:Prevalence; D012256:Riboflavin / Q000008:administration & dosage; D013019:South Africa / Q000453:epidemiology; D014801:Vitamin A / Q000008:administration & dosage; D014807:Vitamin D / Q000008:administration & dosage*; D014808:Vitamin D Deficiency / Q000150:complications* / Q000453:epidemiology; D015032:Zinc / Q000008:administration & dosage / Q000172:deficiency
D018977:Micronutrients; D014801:Vitamin A; D014807:Vitamin D; D007501:Iron; D015032:Zinc; D002118:Calcium; D012256:Riboflavin
Calcium intake; Milk intake; Preschool children; Stunting; Vitamin D intake