Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood: Early and Long-term Consequences of Nutritional Stunting

Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood

Early and Long-term Consequences of Nutritional Stunting


  • Vincenzo De Sanctis Quisisana Hospital, Ferrara
  • Ashraf Soliman Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
  • Nada Alaaraj Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
  • Shayma Ahmed Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
  • Fawziya Alyafei Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
  • Noor Hamed Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar


Stunting, nutrition, growth, cognition, early and long-term consequences


Summary. Linear growth failure (stunting) in childhood is the most prevalent form of undernutrition globally. The debate continues as to whether children who become stunted before age 24 months can catch up in growth and cognitive functions later in their lives. The potentially irreparable physical and neurocognitive damage that accompanies stunted growth is a major obstacle to human development. This review aims at evaluation and summarizing the published research covering the different aspects of stunting from childhood to adulthood.


1. UNICEF. Improving Child Nutrition. The achievable imperative for global progress. UNICEF, 2013. https://www.unicef.org/infobycountry/stats_popup2.html.
2. Semali IA, Tengia-Kessy A, Mmbaga EJ, Leyna G. Prevalence and determinants of stunting in under-five children in central Tanzania : remaining threats to achieving Millennium development goal 4. BMC Public Health. 2015;4–9.
3. Francisco J, Ferrer L, Serra-Majem L. Factors associated with stunting among children. Nutrients. 2017;9:1–16.
4. Caleyachetty R, Thomas GN, Kengne AP, et al. The double burden of malnutrition among adolescents: analysis of data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys in 57 low- and middle-income countries. Am J Clin Nutr. 2018; 108:414-424.
5. Kramer CV, Allen S. Malnutrition in developing countries. Paediatr Child Health. 2015; 25:422–427.
6. Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatr Int Child Health. 2014; 34:254–264.
7. Dewey KG, Begum K. Long-term consequences of stunting in early life. Matern Child Nutr. 2011; 7:5–18
8. Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition 1- Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008; 371:243- 260.
9. Bergvall N, Iliadou A, Johansson S, Tuvemo T, Cnattingius S. Risks for low intellectual performance related to being born small for gestational age are modifi ed by gestational age. Pediatrics. 2006); 117;460–467.

10. Gale CR, O’Callaghan FJ, Godfrey KM, Law CM, Martyn CN. Critical periods of brain growth and cognitive function in children. Brain,2004; 127:321–329.

11.Roth DE, Krishna A, Leung M, Shi J, Bassani DG, Barros AJD. Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993– 2015). Lancet Glob Health. 2017; 5:1249– 1257.

12. Black RE, Victora CG, Walker SP. Maternal and child undernu¬trition and overweight in low-income and middle-income countries. Lancet. 2013; 382: 427–451.

13. Benedict RK, Schmale A, Namaste S. Adolescent nutrition 2000–2017: DHS data on adolescents age 15–19. DHS Comparative Report No. 47. Rockville, Maryland; 2018.

14-Satyanarayana K, Radhaiah G, Mohan KR, et all. The adolescent growth spurt of height among rural Indian boys in relation to childhood nutritional background: an 18-year longitudinal study. Ann Hum Biol. 1989;16 :289-300.
15. Semba RD, Trehan I, Gonzalez-Freire M, et al. Perspective: The Potential Role of Essential Amino Acids and the Mechanistic Target of Rapamycin Complex 1 (mTORC1) Pathway in the Pathogenesis of Child Stunting. Adv Nutr. 2016; 7:853-865.

16. Semba RD, Shardell M, Sakr Ashour FA, et al. Child Stunting is Associated with Low Circulating Essential Amino Acids. EBioMedicine. 2016; 6:246-252.
17. Sancak Y, Bar-Peled L, Zoncu R, Markhard AL, Nada S, Sabatini DM. Ragulator-Rag complex targets mTORC1 to the lysosomal surface and is necessary for its activation by amino acids. Cell. 2010; 141:290–303.

18. Demetriades C, Doumpas N, Teleman AA. Regulation of TORC1 in response to amino acid starvation via lysosomal recruitment of TSC2. Cell. 2014; 156:786–799.

19. Fall CH, Yajnik CS, Rao S, Davies AA, Brown N, Farrant HJ. Micronutrients and fetal growth. J. Nutr .2003;133:1747–1756.

20. Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatr Int Child Health. 2014; 34:250-265.

21. Levitsky DA, Strupp BJ: Malnutrition and the brain: undernutrition and behavioural development in children. J Nutr. 1995;125: 2212-2220.

22. Sandjaja, Poh BK, Rojroonwasinkul N, et al. Relationship between anthropometric indicators and cognitive performance in Southeast Asian school-aged children. Br J Nutr. 2013;110 (Suppl 3) 57–64.

23. Fernald LC, Grantham-McGregor SM. Stress response in school-age children who have been growth retarded since early childhood. Am J Clin Nutr. 1998; 68:691–698.

24. Rosenberg M. Global child health: burden of disease, achievements, and future challenges. Curr Probl Pediatr Adolesc Health Care. 2007; 37:338–362.

25. Walker SP , Wachs TD, Gardner JM, et al ; International Child Development Steering Group. Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007 ;369:145-157.

26. Kar BR, Rao SL, Chandramouli BA. Cognitive development in children with chronic protein energy malnutrition. Behav Brain Funct. 2008 Jul 24;4:31. doi: 10.1186/1744-9081-4-31.

27. Upadhyaya SK, Saran A, Agarwal DK, Singh MP, Agarwal KN. Growth and behaviour development in rural infants in relation to malnutrition and environment. Indian Pediatr. 1992;29: 595-606.

28. Upadhyaya SK, Agarwal KN, Agarwal DK.Influence of malnutrition on social maturity, visual motor coordination and memory in rural school children. Indian J Med Res. 1989;90:320-327.

29. Alderman H, Behrman JR, Glewwe P, Fernald L, Walker S. Evidence of Impact of Interventions on Growth and Development during Early and Middle Childhood. In: Bundy DAP, Silva Nd, Horton S, Jamison DT, Patton GC, editors. Child and Adolescent Health and Development. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov. Chapter 7.
30. Galler JR, Koethe JR, Yolken RH. Neurodevelopment: The Impact of Nutrition and Inflammation During Adolescence in Low-Resource Settings. Pediatrics. 2017;139 (Suppl 1):S72-S84.

31. Kurtz K. Adolescent nutritional status in developing countries. Proc Nut Soc.1996; 55:321–331
32. Coly AN, Milet J, Diallo A, Ndiaye T, Bénéfice E, Simondon F, Wade S, Simondon KB. Preschool stunting, adolescent migration, catch-up growth, and adult height in young senegalese men and women of rural origin. J Nutr. 2006; 136:2412-2420.
33. Stein AD, Thompson AM, Waters A. Childhood growth and chronic disease: evidence from countries undergoing the nutrition transition. Matern Child Nutr. 2005;1:177-184.
34. Ozaltin E, Hill K, Subramanian SV. Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries. JAMA. 2010;303:1507-1516.
35. Hawkes CP, Grimberg A. Insulin-Like Growth Factor-I is a Marker for the Nutritional State. Pediatr Endocrinol Rev. 2015;13:499-511.

36. Soliman AT, Hassan AEHI, Aref MK, et al. Serum insulin-like growth factors I and II concentrations and growth hormone and insulin responses to arginine infusion in children with protein-energy malnutrition before and after nutritional rehabilitation. Pediatr Res.1986; 20:1122-1130.

37.Bartz S, Mody A, Hornik C, et al. Severe acute malnutrition in childhood: hormonal and metabolic status at presentation, response to treatment, and predictors of mortality. J Clin Endocrinol Metab. 2014; 99:2128–2137.

38. Uauy R, Kurpad A, Tano-Debrah K,et al. Role of Protein and Amino Acids in Infant and Young Child Nutrition: Protein and Amino Acid Needs and Relationship with Child Growth. J Nutr Sci Vitaminol (Tokyo). 2015; 61(Supp l):S192-194.

39. Arsenault JE, Brown KH. Effects of protein or amino-acid supplementation on the physical growth of young children in low-income countries. Nutr Rev. 2017; 75:699-717.
40. Victora CG, Adair L, Fall C, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet.2008; 371: 340–357.
41. Kajubi SK. The endocrine pancreas after kwashiorkor. Am J Clin Nutr. 1972; 25:1140-1142.

42. Soliman AT, ElZalabany MM, Salama M, Ansari BM. Serum leptin concentrations during severe protein-energy malnutrition: Correlation with growth parameters and endocrine function. Metabolism. 2000;49:819–825.

43. González-Barranco J, Ríos-Torres JM, Castillo-Martínez L, et al. Effect of malnutrition during the first year of life on adult plasma insulin and glucose tolerance. Metabolism. 2003;52:1005-1011.
44. Martins VJB, Toledo Florêncio TMM, Grillo L P, et al.Long-Lasting Effects of Undernutrition. Int J Environ Res Public Health. 2011;8:1817-1846.
45. Fekadu S, Yigzaw M, Alemu S, et al. Insulin-requiring diabetes in Ethiopia: associations with poverty, early undernutrition and anthropometric disproportion. Eur J Clin Nutr. 2010;64:1192-1198.
46. Bréant B, Gesina E, Blondeau B. Nutrition, glucocorticoids and pancreas development. Horm. Res. 2006, 65:98-104.
47. Yajnik C S. Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries. J Nutr. 2004;134:205-210.
48. Martins PA, Sawaya A L. Evidence for impaired insulin production and higher sensitivity in stunted children living in slums. Br J Nutr. 2006:95:996-1001.
49.Gluckman PD, Hanson MA, Beedle AS. Early life events and their consequences for later disease: a life history and evolutionary perspective. Am J Hum Biol. 2007;19:1-19.
50. Herman JP, McKlveen JM, Ghosal S, et al. Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response. Compr Physiol. 2016;6:603-621.

51. Alleyne GAO, Young VH. Adrenocortical function in children with severe protein-calorie malnutrition. ClinSci. 1967;33:189-200.

52. Soliman AT, Aref M K, Hassan AHI. Hormonal changes in protein energy malnutrition. Indian J Pediatr.1988;55:465–469.

53. Soliman AT, Hassan A, Aref M K, D. Rogol AD. Serum Cortisol Concentrations in Children with Protein-Energy Malnutrition. Ann Saudi Med. 1989;9:6.doi.org/10.5144/0256-4947.1989.533.

54. Büyükgebiz B, Oztürk Y, Yilmaz S, Arslan N. Serum leptin concentrations in children with mild protein-energy malnutrition and catch-up growth. Pediatr Int. 2004; 46:534–538.

55. Carter WJ, Shakir KM, Hodges S, et al. Effect of thyroid hormone on metabolic adaptation to fasting. Metabolism. 1975; 24:1177-1183.

56. Burman KD, Wartofsky L, Dinterman RE, et al. The effect of T3 and reverse T3 administration on muscle protein catabolism during fasting as measured by 3-methylhistidine excretion. Metabolism. 1979;28:805-813.

57.Parra A, Garza C, Garza Y, et al. Changes in growth hormone, insulin and thyroxine values, and in energy metabolism of marasmic infants. J Pediatr. 1973; 82:133-142.

58. Saenger P, Czernichow P, Hughes I. Small for gestational age short Stature and beyond. Endocr Rev. 2006:28;219-252.
59.Rasyid H, Bakri S. Intra-uterine Growth Retardation and Development of Hypertension. Acta Med Indones. 2016;48:320-324.

60. Franco MC, Casarini DE, Carneiro-Ramos MS, Sawaya AL, Barreto-Chaves ML, Sesso R. Circulating renin-angiotensin system and catecholamines in childhood: is there a role for birthweight? Clin Sci (Lond). 2008114:375-380.
61. Sawaya AL, Sesso R, Florêncio TM, Fernandes MT, Martins PA. Association between chronic undernutrition and hypertension. Matern Child Nutr. 2005;1:155-163.
62. Fernandes MT, Sesso R, Martins PA, Sawaya AL. Increased blood pressure in adolescents of low socioeconomic status with short stature. Pediatr Nephrol. 2003;18:435-439.
63. Sawaya AL, Dallal G, Solymos G, et al. Obesity and malnutrition in a Shantytown population in the city of São Paulo, Brazil. Obes Res. 1995;3 (Suppl 2):107s-115s.
64. Sawaya AL, Grillo LP, Verreschi I, da Silva AC, Roberts SB. 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. 1998;128 (2 Suppl):415S-420S.
65. Hoffman DJ, Sawaya AL, Verreschi I, Tucker KL, Roberts SB. 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. 2000;72:702-707.
66. Sawaya AL, Roberts S. Stunting and future risk of obesity: principal physiological mechanisms. Cad Saude Publica. 2003;19 (Suppl 1):S21-28.
67. Popkin BM, Richards MK, Montiero CA. Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. J Nutr. 1996;126:3009-3016.
68.Pryer JA. Body mass index and work-disabling morbidity: results from a Bangladeshi case study. Eur J Clin Nutr. 1993;47:653-657.
69.Durnin JV. Low body mass index, physical work capacity and physical activity levels. Eur J Clin Nutr. 1994;48 (Suppl 3): 39-43.
70. Haas JD, Murdoch S, Rivera J, Martorell R. Early nutrition and later physical work capacity. Nutr Rev. 1996;54:41-48.
71. Martorell R. Improved nutrition in the first 1000 days and adult human capital and health. Am J Hum Biol. 2017;29(2):10.1002/ajhb.22952. doi: 10.1002/ajhb.22952







How to Cite

De Sanctis V, Soliman A, Alaaraj N, Ahmed S, Alyafei F, Hamed N. Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood: Early and Long-term Consequences of Nutritional Stunting. Acta Biomed [Internet]. 2021 Feb. 16 [cited 2024 Jul. 19];92(1):11346. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/11346