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Malnutrition double burden in SA

- By Kemantha Govender

South Africa is starting to see the double burden of malnutrition as the country’s children struggle with both stunting and obesity at the same time.

Speaking at his inaugural lecture on 18 August 2015, Professor Shane Norris who is based at the Developmental Pathways for Health Research Unit, Faculty of Health Sciences, said despite the notable economic transitions since the start of its democratic era, the country stills struggle with issues such as stunting, especially in children under five-years of age. South Africa also has one of the highest number obesity prevalence rates in adults on the continent.

“We have [also] seen an increase in obesity as economic improvement happened in South Africa. So it is not surprising then with the increase in obesity we are seeing increases in metabolic and non-communicable diseases in the country,” said Norris, who joined the University in 1998 as a post graduate student and a research officer.

Inequality persists 

Between 1900 and 2004, 26 critical policies that affected children were implemented in South Africa. There was an increase in the country’s gross domestic product, meaning significant economic growth of the cohort from their birth in 1990 and as they went through childhood, but this did not mean these factors translated into equality.

Norris presented results from his longitudinal research, conducted in collaboration with several academics and post graduate students, over a 25 year period since 1990, which investigated how Soweto, Johannesburg, has transitioned and its impact on children's growth and development, and the implications for adult obesity, diabetes, and hypertension-risk.

“We are very fortunate to have data over a 25 year period and if we piece this together we can understand how children grow,” said Norris.

The study was conceptualised in 1988/9 by a group of scientists that could see change happening in the country and put forward a longitudinal study to capture how this change would influence growth and development of children

The scientists used a 20 years cohort, which has now three generations – the original mothers; the birth of 20 participants who are now 25-years-old; and their babies that they are starting to have.

There is also a sub-cohort – the bone health cohort, initiated by Professor John Pettifor.

The idea was to take the sub-group of participants from the birth to 20 cohort and follow them intensively from 1999 onwards to capture what happens during adolescence and how does this period impact growth and development.

Development differences 

Some of the other aspects of the longitudinal studies showed that the growth pattern between white and black girls is similar.

“Their maturity in terms of the peak height velocity almost coincides, but by the time they reach adult height there is only a small difference between white and black girls within this cohort of about five cms,” said Norris.

There was a difference in the timing of the peak between white and black boys. White boys peaked earlier than black boys, but they followed a similar growth trajectory.

Because of the black boys starting their peak growth spurt a little later but finishing more or less the same time, they have a slightly truncated height. By the time they reach adulthood there is a greater difference between white and black boys.

With skeletal development, there were distinct patterns with girls moving into skeletal maturity sooner than boys, with no difference between the races in girls. However, white boys reached skeletal maturity earlier than black boys.

Norris said his unit is also doing some interesting new work on the intergenerational work. For example, one of the best indicators of a child’s future weight is that of the grandmother. If the grandmother is small, the child is also likely to be small.