Pediatric Nutrition in Practice

4 Michaelsen

play a role in the effects of breastfeeding on long-
term health. Differences in protein intake (qual-
ity and quantity) between breast- and formula-
fed infants are likely responsible for some of the
differences in growth pattern between breastfed
and formula-fed infants. This is in line with evi-
dence suggesting that cow’s milk promotes linear
growth, even in well-nourished populations [7].
There is some evidence suggesting that high
protein intake during the first years of life is as-
sociated with an increased risk of developing
overweight and obesity later in life [8, 9]. Other
aspects of nutrition are also important in devel-
opment of over we i g ht a nd ob e sit y, a s d i s c u s s e d i n
Chapter 3.5.

Nutritional Problems Affecting Growth

Globally, the most common cause of growth fail-
ure is inadequate dietary quality and, in some
cases, insufficient energy intake. Growth-related
nutrients, e.g. zinc, magnesium, phosphorus and
essential amino acids, are important. Overall,
protein deficiency is seldom a problem, but if the
protein quality is low (typically in diets based on
cereals or tubers), essential amino acids such as
lysine may be low in the diet, and this can have a
negative effect on growth. Undernutrition, i.e. low
weight-for-age, can be caused by low height-for-
age (stunting), low weight-for-height (wasting or
thinness) or a combination. In populations with
poor nutrition, stunting is regarded as a result of
chronic malnutrition and wasting a result of acute
malnutrition. However, both forms can coexist in
a given individual; thus this nomenclature is often
an oversimplification. Many acute and chronic
diseases result in poor appetite and eating difficul-
ties, and thus lead to malnutrition. Infections and
diseases with inflammation, such as autoimmune
diseases and cancers, are associated with anorexia.
Psychological problems can cause non-organic
failure to thrive and eating disorders with anorex-
ia can cause severe malnutrition.

Obesity is characterised by an increased body

fat mass, but as fat mass is too complicated to

measure routinely, BMI [weight (kg)/height (m)^2 ]

is commonly used to describe overweight and

obesity. Children with overweight are often taller

than children with normal weight until puberty,

which they typically reach earlier than normal-

weight children. Thus, differences in height after

puberty tend to diminish.

Growth and Long-Term Health

There is strong evidence that deviations from the

average growth pattern, especially during early

life, are associated with impaired mental develop-

ment and increased risk of many non-communi-

cable diseases later in life. Examples are increased

risk of cardiovascular disease in individuals with

low birth weight, and increased risk of type 2

diabetes and obesity in individuals with a high

growth velocity during early life. Height as an

adult is also associated with several diseases, with

a low stature being associated with cardiovascular

disease and a tall stature being associated with

some types of cancer. Early nutrition affects both

early growth and long-term health, as described

in Chapter 1.5. However, the mechanisms are not

clear and there is limited information on the

extent to which either deviations in growth by

themselves or the factors responsible for these de-

viations in growth are the ‘real’ cause of increased

disease risk in later life.

Growth Monitoring

Regular measurements of weight and height and

plotting of weight curves during infancy and

childhood are important tools in monitoring the

health of children in both the primary health care

system and in hospital settings. Weight-for-age

curves are not sufficient, as it is not possible to de-

termine whether the reason a child has a low

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 1–

DOI: 10.1159/