Successful Reversal of Stunted Growth Challenges WHO Guidelines

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Successful Reversal of Stunted Growth Challenges WHO Guidelines

Successful Reversal of Stunted Growth Challenges WHO Guidelines.

Currently, the World Health Organization (WHO) does not recommend the use of nutritional supplements for children with stunted growth.

However, a recent study conducted by the University of Copenhagen suggests that nutritional supplements can reverse stunted growth in children.

Stunted growth, which occurs due to inadequate nutrition, affects over 20% of children under the age of five globally.

While stunted growth may not pose an immediate life-threatening risk like famine, it has long-term adverse effects on a child’s development.

Successful Reversal of Stunted Growth Challenges WHO Guidelines

A recent study challenges the traditional notion that “nutritional supplements cannot stimulate growth in children over two years old.” It demonstrates that even older children with stunted growth can benefit from nutritional supplements, and plant-based proteins are as effective as dairy products in this regard. The image below illustrates the measurement of children’s growth. Image Source: Jack I Lewis, University of Copenhagen.

Typically, these children fall short of their full growth potential by just a few centimeters, a manifestation of their bodies conserving growth resources. However, the differences in height are just the surface. This condition also impacts the normal growth of muscles and organs, hinders cognitive development, and affects their overall health and future prospects.

“Being undernourished means that their bones and muscles don’t get the nutrition they need for optimal growth, especially minerals and proteins,” explained Benedikte Grenov from the Department of Nutrition, Exercise, and Sports at the University of Copenhagen. “This affects the lifelong health and physical abilities of these children.”

Grenov is one of the primary authors of a new study conducted in collaboration between the University of Copenhagen and Uganda’s Makerere University. This research challenges the approaches recommended by the WHO and health authorities worldwide for treating stunted growth in children.

For a long time, it was believed that nutritional supplements couldn’t stimulate growth in children over two years old. Consequently, current initiatives to prevent stunted growth through nutritional supplements primarily focus on providing small amounts of supplements to vulnerable children under the age of two, and even these programs are limited. There are concerns that high-energy supplements might increase the risk of obesity and obesity-related health issues.

According to this new research, this notion is incorrect. Researchers provided nutritional supplements to 750 children with stunted growth in Uganda over a three-month period.

“In fact, our study indicates that there is a problem if you don’t treat children with stunted growth. But if treated, growth impairment can be reversed, even in children over two years old. We have successfully demonstrated this in the children involved in our study. This could potentially mean improved living conditions for these children as adults, making them healthier, stronger, and reducing the risk of lifestyle diseases,” emphasized Benedikte Grenov. “Therefore, we hope these results can contribute to a shift in the approach to treating stunted growth and change recommendations.”

Plant Protein as Effective as Dairy

One aspect of the study investigated whether milk-based nutritional supplements were particularly suitable for improving the lives of many stunted children worldwide.

While the study results clearly indicate the benefits of milk-based supplements for children’s healthy growth, more affordable and environmentally friendly plant-based alternatives are equally effective.

“In fact, we initially expected to see differences because milk contains higher-quality proteins and certain trace nutrients related to promoting growth. But the differences we observed were so minimal that, from a scientific perspective, discussing them is meaningless,” said the researchers. The biggest distinction lay between children receiving supplements and those not receiving them: “This brings a positive outcome that nutritional supplements can be produced at a lower cost and in a more eco-friendly manner. While the plant-based protein we used is a specific type requiring specialized production facilities, plant protein typically has the advantage of being more easily produced on-site in the areas most affected by this issue.”

A Widespread Issue

These advantages are crucial in addressing a strategically significant issue. Globally, approximately 150 million children under the age of five suffer from stunted growth, making any initiatives to help them economically and practically challenging.

Benedikte Grenov acknowledges that treating all children is practically impossible due to the widespread nature of this issue. However, focusing on treatment for severely stunted children, for example, is one approach.

“The good news is that all children, including those severely stunted, can reverse the negative trends and start growing lean mass, which includes muscles and organs, after receiving supplements. In the long term, these children are often stunted in terms of both growth and intelligence. Therefore, if we can start with them on nutritional supplements, we will make significant progress,” Grenov continued. “This could be one approach, and another would be to further explore whether improving the diets of ordinary families with advanced multi-micronutrient ‘vitamin’ pills and more accessible high-quality proteins is possible. In fact, it’s this combination that’s crucial for the optimal growth of children.”

750 children aged 1-5 from Eastern Uganda participated in this study and were tracked for three months by healthcare professionals, including measurements and weight checks. All children suffered from moderate to severe stunted growth.

The children were randomly divided into five groups:

(1-2) Two groups received milk protein supplements. One group also took a mixture of lactose and minerals, known as whey permeate.

(3-4) Two groups received soy protein supplements. One group also took a mixture of lactose and minerals.

(5) The final group served as a control group and did not receive food supplements.

These children continued to eat at home, but the supplements could provide up to half of their energy and protein needs, as well as all their vitamin and mineral requirements.

The control group families received laundry soap, and all participants had their transportation expenses covered by the clinic, receiving food as compensation for their participation in the activities.

The growth status of the control group children remained poor, which is typical for most stunted children. They continued to experience delayed growth, with unhealthy increases in fat instead of lean mass (muscles and internal organs).

Overall, their height and body composition showed negative growth compared to children receiving supplements. Children receiving supplements not only grew taller but also increased lean muscle mass without gaining fat.

Energy-Dense Food

The nutritional supplements used in the study were lipid-based mixtures consisting of blended peanuts, milk or soy protein, vitamins and mineral mixtures, and carbohydrates used as sweeteners.

They had a texture similar to almond butter, with a sweet taste reminiscent of peanut butter.

The mixtures were packaged in sachets, requiring no mixing to avoid contamination, and children could consume them directly.