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close this bookCauses and Mechanisms of Linear Growth Retardation (International Dietary Energy Consultative Group - IDECG, 1993, 216 pages)
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View the documentEuropean journal of clinical nutrition
View the documentForeword
Open this folder and view contentsIntroduction: Causes and mechanisms of linear growth retardation (stunting)
Open this folder and view contentsBetween-population variation in pre-adolescent growth
Open this folder and view contentsPrenatal influences on postnatal growth: Overview and pointers for needed research
Open this folder and view contentsLinear growth retardation in relation to the three phases of growth
Open this folder and view contentsReversibility of stunting: Epidemiological findings in children from developing countries
Open this folder and view contentsIs complete catch-up possible for stunted malnourished children?
Open this folder and view contentsRelationship of gain in height to gain in weight
Open this folder and view contentsNutritional influences on linear growth: A general review
Open this folder and view contentsOnset and evolution of stunting in infants and children. Examples from the Human Nutrition Collaborative Research Support Program. Kenya and Egypt studies
Open this folder and view contentsEffects of macrobiotic diets on linear growth in infants and children until 10 years of age
Open this folder and view contentsPsychosocial adversity and growth during infancy
Open this folder and view contentsThe cell biology of bone growth
Open this folder and view contentsHormonal regulation of longitudinal bone growth
Open this folder and view contentsAdequacy of dietary mineral supply for human bone growth and mineralisation
Open this folder and view contentsThe mechanical factors which influence bone growth
Open this folder and view contentsInfluence of exercise on linear growth
Open this folder and view contentsThe effects of the inflammatory response on bone growth
Open this folder and view contentsBiochemical markers for assessing skeletal growth
Open this folder and view contentsSummary of causes and mechanisms of linear growth retardation
View the documentSummary of research needs in the area of linear growth retardation
Open this folder and view contentsGuidelines for the study of mechanisms involved in the prevention or reversal of linear growth retardation in developing countries
View the documentEuropean journal of clinical nutrition - Directions to contributors

Summary of research needs in the area of linear growth retardation

J.C. Waterlow

1. More observational studies on different groups in different parts of the world are not needed, unless there are groups presenting special features which allow us to separate out or eliminate some causal factors. Examples would be children on macrobiotic diets or the children described by Skuse.

2. However, linear growth measurements should be incorporated in other studies, as of vitamin A or iodine deficiency, of iron supplementation, etc.

3. Further longitudinal studies of child growth will also be valuable if they are accompanied by good data on fetal growth and maturity.

4. There was some difference of opinion on whether more different physical measurements are needed, e.g. of arm length or crown-rump length. These would be valuable for showing whether stunting is proportionate or is confined to the legs.

5. Although this meeting has not been primarily concerned with outcomes, there is a need for more research on the implications of stunting, particularly its effect on the timing of puberty and on final height. A literature review would be a useful first step.

6. Priority should be given to feeding trials, although there was no consensus about whether these should be done with whole foods, such as milk, or with single individual nutrients, e.g. sulphur amino acids. A protocol should be worked out by a special group, which would take account of past experience.

7. Further surveys of dietary intakes, without intervention, are not recommended unless new methods are used to validate the intakes.

8. Studies are needed on the presence and impact of low-grade infections on linear growth, using modern methods to determine the presence and degree of infection. New methods may have to be developed.

9. It is important to continue the development and use of biochemical markers by collaboration between different centres. Attention must be given to technical aspects to ensure that results are comparable.

10. Importance is attached to the measurement of growth hormone, particularly between the ages of 6 and 12 months, to determine the onset of the childhood phase of growth. In this context there is need to promote the development of methods for measuring GH in urine, which would give an integrated measure of hormone production.

11. It is still very difficult to interpret measurements of GH or IGF-1 in plasma. It is now possible to measure their binding proteins and their receptor proteins. Consideration should be given to measuring these proteins or their mRNAs in samples of muscle, fat or bone obtained by biopsy.