Poor quality water may be responsible for stunting | AGÊNCIA FAPESP

Poor quality water may be responsible for stunting According to Helen Raikes, a researcher at the University of Nebraska-Lincoln, recurrent bacterial infections early in life may permanently alter the intestines’ ability to absorb nutrients (photo: Marcelo Casal Jr. / Agência Brasil)

Poor quality water may be responsible for stunting

September 21, 2017

By Karina Toledo, in Lincoln (USA)  |  Agência FAPESP – Reducing infant mortality rates was one of the Millennium Development Goals announced by the United Nations (UN) in 2000. Actually, several advances in this regard have been achieved around the world over the last two decades.

“Children are surviving longer, in countries both developed and less developed. However, a good number of them are not thriving as they could, and are thus unable to reach their full potential in terms of cognitive and physical development. And this has enormous implications for the countries,” said researcher Helen Raikes, of the College of Education and Human Sciences at the University of Nebraska-Lincoln, in the United States.

In a lecture given on Tuesday (9/19) during FAPESP Week Nebraska-Texas, Raikes talked about how the lack of basic sanitation and access to clean drinking water may be behind problems such as stunting and other conditions associated with malnutrition.

“There is a well-established relationship between the occurrence of frequent diarrhea and infant mortality. However, recent studies have shown that recurrent bacterial infections can affect the intestinal villi and microbiota profile, impairing the absorption of nutrients for the rest of one’s life,” the researcher said.

When the problem occurs during periods of increased vulnerability, such as in the first two years of life, the damage can be permanent. According to Raikes, three areas are particularly compromised: cognitive development, stature, and the intestinal microbiome (closely related to metabolic health and immunity). “Such condition creates major disparities in the development of children from different socioeconomic backgrounds and causes loss of human potential,” the researcher said.

As Raikes noted, neuroscience has shown that an individual’s early life experiences are built into our bodies and establish the bases for future experiences. Each period of development, the researcher said, is built upon the one that precedes it.

An overview from Acre

The importance of the first 1,000 days of life for childhood development was also discussed in a lecture by Marly Augusto Cardoso, a professor at the School of Public Health (FSP) of the University of São Paulo (USP), Brazil. On Tuesday (9/19), she presented the findings of a 10-year study (2003-2012) conducted in the municipality of Acrelândia (in the Brazilian state of Acre) involving nearly 1,000 children under the age of 10.

“What is striking about this region, in relation to the national scenario, is that child malnutrition – and as a result, stunting and the prevalence of anemia – has not decreased as drastically as it has in other Brazilian states. Acre still has very poor child health indicators. The occurrence of diarrhea in small children, for example, is much more common there than in other regions,” Cardoso said.

At the same time, the researcher noted to Agência FAPESP, researchers are seeing excessive weight gain among school-age children – possibly caused by the replacement of traditional dietary patterns with modern ones that consist mainly of processed foods.

“This poses a double burden in terms of diseases related to the nutritional status: there are still deficiencies that have not been completely resolved while at the same time, there is a risk of excessive weight gain that predisposes individuals to cardiovascular and metabolic diseases in their adult life,” she said.

The study in Acrelândia was carried out with funding from FAPESP during the doctoral studies of Bárbara Hatzlhoffer Lourenço.

Cardoso is currently coordinating a Thematic Project in the municipality of Cruzeiro do Sul – the second most populated municipality in Acre and a region in which malaria is endemic – that aims to identify factors that may enhance both the promotion of health in school life and adolescence as well as the reduction of risk factors in adulthood.

The population-based study, which began in 2015, plans to monitor the determinants of maternal and infant health from pregnancy and birth to the end of second year of life. Nearly 1,500 families selected from the city’s only maternity hospital are participating in the study, thanks to a partnership with officials of the Family Health Program (PSF). Students and faculty from the Federal University of Acre (UFAC) are also taking part in the study.

“The project has several themes. We are going to study nutritional deficiencies in the mothers and children, the risk of infection from malaria and dengue, precocious weight gain, and mothers’ eating habits. We also plan to study the intestinal microbiota of the volunteers and conduct epigenetic analyses [to understand how environmental factors are modulating gene express],” Cardoso said.

A pilot study conducted with 500 expectant mothers from the same municipality showed that are 19% are teenagers – a rate higher than the national average. In addition to this, 24% are overweight, 18.7% did not gain enough weight during pregnancy, and conversely, 59% gained excessive weight during the period (although they were not necessarily above the average considered ideal when they were assessed). The rate of anemia during the third trimester of pregnancy was 17.5%, and 13.4% presented a deficiency in vitamin A.

“Something that we are already seeing is that gestational malaria is an overlooked problem and we know it to be one of the causes of low birth weight,” she said.

On the preceding day, also as part of the schedule for FAPESP Week Nebraska-Texas, Susan Sheridan, director of the Nebraska Center for Research on Children, Youth, Families and Schools, presented a series of studies focused on promoting family mental health and in this way enabling better childhood development.

According to Sheridan, a collaborative study carried out by researchers from Brazil and Nebraska concluded that children fare better when their parents have a strong relationship. That line of research is currently identifying interventions that could improve family relationships, such as teletherapy. For more information visit: cehs.unl.edu/cehs/brasil.


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