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    Linear Growth Retardation in Less Developed Countries / ed. J. C. Waterlow. - New York : Raven press, 1987. - xvi, 295 p. : il. - (Nestle Nutrition Workshop Series ; vol. 14). - Contributors: p. xiii-xv. - На англ. мові. - References at the end of articles. - Subjekt Index: p. 285-295. - ISBN 0-88167-378-1 : 001.00 р.
Переклад назви: Лінійного зросту затримка в менш розвинених країнах
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Анотація: Contents Observations on the Natural History of Stunting 1 J. C. Waterlow The Epidemiology of Stunting 17 W. Keller The Use of Short-Term Increments in Length to Monitor Growth in Infancy 41 M. J. R. Healy, M. Yang, J. M. Tanner, and F. Y. Zumrawi Poverty and Stature in Children 57 R. Martorell, F. Mendoza, and R. Castillo The Importance of Genetic Influences on Growth in Early Childhood with Particular Reference to Children of Asiatic Origin 75 D. P. Davies Determinants of Growth in Utero 91 R. D. G. Milner Endocrine Control of Growth 109 R. Rappaport Nutritional Growth Retardation: Experimental Studies with Special Reference to Calcium 127 D. R. Fraser The Role of Individual Nutrient Deficiencies in Growth Retardation of Children as Exemplified by Zinc and Protein 143 M. H. N. Golden xi xii CONTENTS The Importance of Infections and Environmental Factors as Possible Determinants of Growth Retardation in Children 165 D. Nabarro, P. Howard, C. Cassels, M. Pant, A. Wijga, and N. Padfield The Risk of Morbidity in a Stunted Child 185 A. Tomkins Mental Development and Stunting 201 M. Colombo, I. de Andraca, and I. Lopez Body Size, Physical Work Capacity, and Productivity in Hard Work: Is Bigger Better? 215 G. B. Spurr Linear Growth Retardation and Mortality 245 W. Van Lerberghe Stunting: Significance and Implications for Public Health Policy 265 C. Gopalan Subject Index 285 Preface In many Third World countries, 30% or more of children under 5 years may be diagnosed as malnourished solely on the basis of a low height or length for age by comparison with international standards. For brevity this deficit in linear growth is often referred to as stunting, a term that was introduced because it is purely descriptive. What right have we to diagnose this growth deficit as malnutrition? There is grave danger of a circular argument. It is probably true that nutritional deficiency in general leads to impairment of linear growth; it is certainly not true that all such impairment is caused by malnutrition, although there may perhaps be a common final metabolic or endocrine pathway. If one asks, "How do we know that malnutrition causes this growth deficit in the Third World?" the only answer in the present state of knowledge is that the existence of the deficit defines the presence of malnutrition. This is clearly a most unsatisfactory situation, particularly because the problem is not a trivial one. Stunting is not only very prevalent, but it has important social implications, since it is widely regarded as an index of poverty. At the biological level, some look on stunting as a useful adaptation that enhances the chances of survival; others emphasize the physical and psychological handicaps that may be associated, directly or indirectly, with stunting. It seems that the only way to make progress in this situation is to withdraw from concepts that cannot be defined, such as malnutrition and poverty, and to look objectively at the facts that we do have: the epidemiology and natural history of the process; the biological mechanisms that determine growth failure, because in the end there must be a metabolic cause; the environmental factors that set the process going; and the handicaps, if any, associated with it or even caused by it. The question has important implications for policy. Are these large numbers of children malnourished in any meaningful way? I myself do not think it is enough simply to say that stunting is an index of poverty and that this requires a holistic approach. This may be true, but it is not particularly helpful. A useful approach may be that if we regard stunting as an indicator, it is difficult to develop a rational policy, even a policy to do nothing, unless we know more about what the indicator really means. Such knowledge should help in using limited resources more effectively. This position is an article of faith, and I do not expect everyone to agree with it. Nevertheless, I do believe that the Workshop may have contributed to a better definition of the problem and hence may stimulate further research and discussion. JOHN C. WATERLOW Acknowledgments As the initiator of the Fourteenth Nestle Nutrition Workshop, I wish to record my gratitude to Nestle for its generous and imaginative support, and in particular to Dr. P. Guesry, who made that support possible. We are greatly indebted to M. P. Guinand and his colleagues who were responsible for the arrangements in Thailand; to Dr. P. Goyens for his assistance in editing the discussions, and to Mrs. Jennifer Bohn-Pink who surmounted the difficulties of transcribing them. vu Foreword The idea of this workshop, Linear Growth Retardation in Less Developed Countries, came from the need to get a better understanding of a condition that, though extremely common, has been studied very little from a scientific point of view. What could be more appropriate than a Nestle Nutrition Workshop bringing together research scientists and practicing pediatricians in a forum for discussion of the subject in depth? Many aspects of "nutritional stunting" were extensively discussed, with contributions from epidemiologists, auxologists, nutritionists, endocrinologists, and pediatricians. More questions were raised than can be answered, but progress was made in defining the extent of the problem, its implications for pediatricians, and the needs for further research. PIERRE R. GUESRY, M.D. Vice President NESTEC Ltd. Avenue Nestle 55 1800 Vevey, Switzerland
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