JIS News

Susan Walker, Professor of Nutrition at the Tropical Metabolism Research Institute (TMRI) at the University of the West Indies (UWI), has pointed to the need for further research into clinical malnutrition and chronic under nutrition in children, as represented by stunting.
Professor Walker, who was speaking at a regional workshop on child nutrition on Wednesday (April 5) at the Planning Institute of Jamaica’s (PIOJ) New Kingston offices, said that the research should include “investigation of specific nutrients aimed at ensuring that malnourished children gain sufficient lean body mass during recovery or to promote catch up growth in stunted children”.
She noted that the TMRI, through its Tropical Metabolism Research Unit, the Sickle Cell Unit and the Epidemiology Research Unit on the Mona campus and a fourth unit based at Cave Hill, Barbados, has been focusing research on under-nutrition. “Seminal research conducted at the TMRI on the metabolism of malnourished children led to marked improvements in the treatment of malnourished children”, she said.
She noted that the programme for the management of severely malnourished children developed by the TMRI, had become the internationally accepted best practice and formed the basis for the World Health Organisation (WHO) manual on the treatment and management of severe malnutrition.
The work included investigation of protein and nitrogen metabolism as well as understanding of the energy metabolism of the recovering malnourished child and the tremendous energy requirements during the period of rapid weight gain.
Further, the Professor said, work on amino acid metabolism has continued at the TMRI, and should provide important information on the requirements of malnourished children for optimal recovery. “Although this research now has less importance for most of the Caribbean region, it remains of considerable importance globally,” she stated.
Following on the work on severe malnutrition, the research group at the TMRI began to focus on the problem of stunting, which affected a third of children under five years of age in developing countries. A longitudinal study began in 1986 and enrolled stunted and non-stunted children from several low-income neighbourhoods in Kingston.
As Professor Walker explained, “the focus of the study was on the developmental consequences of stunting and the stunted children participated in a two year randomized trial of stimulation and nutritional supplementation given singly or together.” In the initial study, the development of the stunted children was found to be substantially below that of the non-stunted children.
“The children have now followed to age 18 years and the intervention of providing stimulation through parent training in weekly home visits, has had sustained benefits to their cognitive ability and behaviour,” she disclosed. In contrast, benefits from supplementation were not seen after age seven.
The growth of the children, she said, was extremely interesting, as many of the stunted children had shown substantial catch up growth.
“Given the cross sectional associations that have been reported between stunting and obesity, we investigated the participants weight status at age 18 years. There was no indication that the stunted children were at increased risk of later obesity and in fact, they had lower Body Mass Index (BMI) than the non-stunted group,” Professor Walker informed.
She noted however, that increasing attention would have to be paid to the problem of obesity in children. She said that while the prevalence of under-nutrition and stunting at the national level were low and mostly in the lower income groups, statistics from the PIOJ’s Survey of Living Conditions (SLC) indicated that for the 1997-2004 period, the prevalence of overweight children up to five years was between four to seven per cent.
“Here, reverse pattern with social class is seen with children in the wealthiest quintile being most at risk,” she remarked, noting that there was limited data on older children among whom being overweight was more likely to be a greater problem.
“Our increasing cohort of stunted children provides the opportunity to look in more detail at the long-term effects of stunting on body composition.it is clear however, that increasing attention will have to be paid to the problem of obesity in children and this should give priority to the development of interventions to prevent overweight in young children and in school aged children,” she stated.
The four-day workshop, held in collaboration with the International Atomic Energy Agency (IAEA), will specifically examine programmes for the reduction of child malnutrition and obesity as well as childhood stunting, and evaluate previous interventions to address these issues.
Participating in the forum are representatives from Central and South American countries including Brazil, Argentina, Bolivia, Chile, Costa Rica, Ecuador, Honduras, Panama, Uruguay, Guatemala, Venezuela and Nicaragua. Jamaica, Haiti and Cuba, the only members of the Caribbean region that are members of the IAEA, are also represented.

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