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Abstract
Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity.
Highlights
Undernutrition is defined by an insufficient provision of energy and nutrients, such as good quality protein with an adequate balance of essential amino acids, vitamins and minerals, and an inability to meet the requirements of the body to ensure growth, maintenance, and specific functions [1]
This may be caused by the resistance to Growth hormone (GH) induced by undernutrition in the liver, reducing the synthesis of insulin-like growth factor (IGF)-1, which leads to an increase in plasma GH, because IGF-1 acts in the central nervous system to control the synthesis of GH via negative feedback [36,37,38,39]
One study that examined the effects of undernutrition in the first year of life on glucose tolerance and plasma insulin found that early undernutrition in the extrauterine period, independent of the birth weight, was associated with hyperinsulinemia and a reduced sensitivity to insulin, which worsened as body mass index (BMI) increased in adult life [75]. We examined these hormonal changes in adolescence and observed that the stunted boys and girls showed plasma insulin levels that were significantly lower when associated with a lower homeostasis model assessment-B (HOMA-B), which evaluates pancreatic b-cell function, than those of a nonstunted group [76]
Summary
Undernutrition is defined by an insufficient provision of energy and nutrients, such as good quality protein with an adequate balance of essential amino acids, vitamins and minerals, and an inability to meet the requirements of the body to ensure growth, maintenance, and specific functions [1]. It should be noted that in this review, the term undernutrition is used in its broadest sense, that is, to mean inadequate nutrition, which includes an insufficient quantity of food as well as an inadequate consumption of food in qualitative terms. This is important because the consumption of energy-dense foods with poor nutrient quality is a problem today that affects developing countries and the poorest populations. This new nutritional situation further increases the impact of the long-lasting effects of undernutrition. We describe some of the studies carried out far illustrating the positive effects of nutritional recovery on weight and height, body composition, and the metabolism of glucose and insulin
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