by Emily Oken, MD, MPH
In July, I attended a workshop on the Healthy Birth, Growth, and Development Initiative organized by the Bill and Melinda Gates Foundation. The workshop brought together experts in nutrition, growth, and statistical modeling to advise the Gates Foundation on its efforts to maximize brain development by interventions during the first 1000 days of life (conception through age 2). What will be their key measure of success?
Interestingly, it won’t be improvements in school performance or IQ, or even head circumference. Their key measure is height. The percent of children who are stunted, i.e. at low height for their age, turns out to be a very good marker for both early nutrition and brain development. As summarized in a paper in The Lancet, children who are stunted by age 2 continue to show deficits in cognition and school achievement until adolescence. Thus, chronic undernutrition in early life seems to have long-lasting consequences for brain development. According to the World Health Organization, globally, 162 million children under age 5 were stunted in 2012, almost 4 times as many children as were overweight.
But it’s not all about having the money to buy food with enough calories and vitamins, as demonstrated by the ‘Indian Paradox.’ India has one of the fastest growing economies in the world, but it also has a rate of stunting that is one of the highest in the world – almost 60%! This rate is much higher than in immediate neighbors like Pakistan and Bangladesh, and is as high as many poorer countries like Haiti. It turns out that many Indians prefer to defecate outdoors, and the resulting chronic exposure to bacteria may keep kids from absorbing all the nutrition they need (view an amazing New York Times graphic on the relationship between outdoor defecation and child stunting).
So, the Gates Foundation has a big challenge: figuring out how to deliver not only healthy food, but also environments free of chemicals and bacteria, to both mothers and children.