Stunting remains as one of global health problems especially in developing countries. According to World Health Organization (WHO), 21.9% of children below 5 years in Malaysia were affected with stunting in 2022. Other South East Asian countries such as Indonesia, Myanmar, and Thailand recorded 31%, 24.1 and 11.8% respectively for stunting prevalence among children below than 5 years old. This high prevalence becomes a major concern because stunting can lead to lost-productivity, poor cognition and educational performance, and increased nutrition-related chronic diseases in adult life.
Malnutrition of children is the main cause of stunting apart from other causes such as poor psychosocial stimulation, infections and chronic diseases. Adequate nutritional intake is very important during the first 1000 days of life to prevent stunting as it promotes children’s growth and development in both prenatal and postnatal period. It is recommended for children to be exclusively breast fed during the first 6 months after being delivered. However, breast feeding alone is insufficient after the 6-month’s period (6-23 months) due to a high demand for micronutrients to support infants’ rapid growth and produce adequate development. The essential micronutrients include zinc, iodine, iron, vitamin A, vitamin D, vitamin B12, and folic acid which are incorporated in animal-based diet rather than plant-based diet. A dietary deficiency of zinc, iron, calcium, and vitamin A is especially common and often occurs together concomitantly.
Each of these micronutrients plays an important role in preventing stunting. Zinc has been shown to promote foetal long bone growth and prevent respiratory complications and diarrhoea in infancy associated with stunting. Other micronutrients have not been as well studied compared to zinc. as a single comparison. However, deficiencies in multiple micronutrients have been associated with poor growth. For example, severe iodine deficiency can cause cretinism, a form of dwarfism.
Dietary supplementation with multiple micronutrients along with energy and macronutrients is required for the management of stunting according to the WHO guidelines. Multiple micronutrients can be delivered as medicinal-like supplements or together with food, e.g., in dairy milk, in fortified dried cereal mixtures to supplement complement foods or in lipid nutrition supplements. In addition, micronutrients powder is also available, which is effectively used to prevent anaemia associated with stunting.
Therefore, it is important to improve infant and child nutrition by providing adequate nutritional intake and promoting food diversity to support their growth and development. It is also important to ensure adherence to dietary supplements and correct administration of the medicinal-like supplements. Some supplements, such as iron supplements, must be taken on an empty stomach for optimal absorption. Adherence to appropriate dosage according to the physician’s order or manufacturers’ leaflet and correct administration of dietary supplements are necessary to optimize efficacy.
Table 1: Summary of reference nutrient intakes for vitamins (units/day):
| Minerals | ≤ 6 months | 7-12 months | 1-3 years |
| A (μg) | 350 | 350 | 400 |
| D (μg) | 8.5 | 7 | 7 |
| E (mg) | 0.4 mg/g PUFA | 0.4 mg/g PUFA | 0.4 mg/g PUFA |
| K (μg) | 10 | 10 | 10 |
| B1 (thiamine) (mg) | 0.2 | 0.2/0.3 | 0.5 |
| B2 (riboflavin) (mg) | 0.4 | 0.4 | 0.6 |
| Niacin (equivalents mg) | 3 | 4/5 | 8 |
| B6 (pyridoxine) (mg) | 0.2 | 0.3/0.4 | 0.7 |
| B12 (μg) | 0.3 | 0.4 | 0.5 |
| Biotin (μg) | Not given | Not given | Not given |
| Pantothenate (mg) | 1.7 | 1.7 | 1.7 |
| Folic acid (μg) | 50 | 50 | 70 |
| C (mg) | 25 | 25 | 30 |
Ref: (Leaf, 2007)
*PUFA: polyunsaturated fatty acids
References:
- Penny M. E. (2012). Micronutrients in the treatment of stunting and moderate malnutrition. Nestle Nutrition Institute workshop series, 70, 11–21. https://doi.org/10.1159/000337388
- Gaston, R. T., Habyarimana, F., & Ramroop, S. (2022). Joint modelling of anaemia and stunting in children less than five years of age in Lesotho: a cross-sectional case study. BMC Public Health, 22(1), 285. https://doi.org/10.1186/s12889-022-12690-3
- Zhang, Y., Wu, Q., Wang, W., van Velthoven, M. H., Chang, S., Han, H., Xing, M., Chen, L., & Scherpbier, R. W. (2016). Effectiveness of complementary food supplements and dietary counselling on anaemia and stunting in children aged 6-23 months in poor areas of Qinghai Province, China: a controlled interventional study. BMJ open, 6(10), e011234. https://doi.org/10.1136/bmjopen-2016-011234
- Leaf, A. A., & RCPCH Standing Committee on Nutrition (2007). Vitamins for babies and young children. Archives of disease in childhood, 92(2), 160–164. https://doi.org/10.1136/adc.2006.109066