- Malnutrition, a pathological abnormality, is a critical child health issue.
- Children exposed to early childhood risk factors suffer not just from stunting but also developmental, cognitive, and learning difficulties.
- Early nutritional interventions for preschoolers are crucial to improve childhood stunting and cognitive abilities in vulnerable populations.
Addressing the malnutrition in preschoolers
Malnutrition is a significant public health concern, and it poses a critical child health issue nationwide.1 A pathological abnormality, malnutrition is caused by inadequate, imbalanced, or overconsumption of the macronutrients (protein, carbohydrates, and fats), supplying dietary energy and the necessary micronutrients (vitamins and minerals) for physical and cognitive development.1 Poor gut integrity is common in malnutrition, which may hamper nutrient absorption and growth.2
Classification of malnutrition
Malnutrition is broadly categorized into:12
Child malnutrition is majorly caused due to undernutrition among children under five years of age. An undernourished child is predisposed to severe ill-health conditions, leading to increased morbidity and mortality.1
Prevalence of malnutrition in preschoolers (<5 years age)
Despite well-concerted efforts, the prevalence of child malnutrition phenomena continues to be high in India. India shares 40% of the global burden of stunted children.1 Child stunting in India is significantly observed among preschool-age children (24 months or older).4 The National Family Health Surveys (NFHS) reports showed high stunting (35.5%) in children bearing preschool days (24–59 months).5 Table 1 shows Indian preschool children's malnutrition per the NHFS-5 report.
Table 1.Malnutrition among preschool children (under five years) (Adapted from NFHS-5 report 2019-21)4
Stunted Children (height-for-age) (%)
Wasted children (weight-for-height) (%)
Severely wasted children (weight-for-height) (%)
Underweight children (weight-for-age) (%)
Overweight children (weight-for-height) 20 (%)
Consequences of malnutrition
An extended malnutrition state among children manifests into:1
- Delayed physical growth
- Weakened cognitive and motor responses
- Reduced intellectual Quotient (IQ) level, cognitive performance
- Diminished psychosocial development
- Reduced body size in adulthood that may hamper the country's economic productivity
Long term implications of early malnutrition are associated with:6
- Increased mortality
- Reduced human capital
- Increased risk of chronic diseases
- Long-term intergenerational complications
About 2.2 million deaths and 21% of disability-adjusted life-years for preschoolers are attributed to severe wasting and stunting. Malnutrition can impair the child's immune responses, rendering to more infections and impaired development. Children with severe wasting (weight-for-height z-score < 3 standard deviations) are particularly susceptible and have a ninefold greater mortality risk than their counterparts.6sup
During the first 1000 days, undernourished children are more vulnerable to chronic disease and gain weight rapidly in later childhood. Interventions for increased birth weight and linear growth during early childhood may offer some protection against chronic diseases. Inability in preventing malnutrition in young children may have long-term irreversible consequences on their development and risk of illness and place future generations at risk. Girls undernourished during childhood have shorter adult heights, and girls born with low birth weight (LBW) tend to have babies with LBW, thus perpetuating the vicious cycle of malnutrition to the next generation.6
Interventions to reduce malnutrition in preschoolers
Nutritional supplementation for preschool and school children has improved childhood stunting and cognitive abilities in vulnerable populations.7 Consequence of early nutritional deprivation is irreversible, and it is crucial to identify nutritional deficiencies in terms of energy, protein, and micronutrient requirements during the early days of life in preschoolers.7 For instance, iron, folic acid, and protein-energy supplementation are critical interventions that have significant potential to improve child nutrition.6
In addition to nutritional interventions, including prebiotics in diet enhances the absorption of many micronutrients, including calcium, zinc, magnesium, and iron, thanks to their binding properties. Various ways by which prebiotics aid in nutrient bioavailability and absorption are given below.8
Nutritional interventions support growth and cognition in preschoolers
Evidence states that incorporating micronutrients such as zinc, vitamin A, and other multiple micronutrients such as riboflavin, vitamin E, Cu, and protein in preschoolers' diets have significant positive effects on their linear growth.9 Also, iron and multiple-micronutrient supplementation significantly improve the cognitive abilities of undernourished preschool-age children.10 Thus, with appropriate, curative interventions at the earliest, we can reverse the chances of malnutrition in preschoolers and maximize the gain in human capital.7
Child malnutrition indicates impaired nutritional status and significantly impacts a child's development and cognitive abilities. Therefore, it is vital to strengthen dietary interventions for children who belong to the preschool age bracket in rural and urban areas. Ensuring the daily intake of zinc, vitamin A, multiple other micronutrients, and prebiotic interventions in preschoolers can have a positive effect on their linear growth, ensure nutritional adequacy, and mitigate childhood predisposition to stunting, wasting, and being underweight. Additionally, it will ensure overall body immune-strengthening, cognitive and psychosocial development, and help build a healthy and robust adult community.
- Das P, Roy R, Das T, Roy TB. Prevalence and change detection of child growth failure phenomena among under-5 children: A comparative scrutiny from NFHS-4 and NFHS-5 in West Bengal, India. Clinical Epidemiology and Global Health. 2021 Oct 1;12:100857.
- Weisz AJ, Manary MJ, Stephenson K, Agapova S, Manary FG, Thakwalakwa C, Shulman RJ, Manary MJ. Abnormal gut integrity is associated with reduced linear growth in rural Malawian children. Journal of pediatric gastroenterology and nutrition. 2012 Dec 1;55(6):747-50.
- Bharadva K, Mishra S, Tiwari S, Yadav B, Deshmukh U, Elizabeth KE, Banapurmath CR. Indian pediatr. 2019 Jul;56(7):577-86.
- Rajpal S, Kim R, Joe W, Subramanian SV. Stunting among Preschool Children in India: Temporal Analysis of Age-Specific Wealth Inequalities. International Journal of Environmental Research and Public Health. 2020 Jan;17(13):4702.
- NHFS-5, 2019-21. [Internet]. http://rchiips.org/nfhs/factsheet_NFHS-5.shtml. Accessed on 20/02/2022.
- Young MF, Martorell R. The public health challenge of early growth failure in India. European journal of clinical nutrition. 2013 May;67(5):496-500.
- Koshy B, Srinivasan M, Gopalakrishnan S, Mohan VR, Scharf R, Murray-Kolb L, John S, Beulah R, Muliyil J, Kang G. Are early childhood stunting and catch-up growth associated with school age cognition? —Evidence from an Indian birth cohort. PloS one. 2022 Mar 2;17(3):e0264010.
- León SC, Vergara PC, Neira AC, Maldonado RM, Araneda CD, Zuñiga MR. Gut microbiota and obesity: prebiotic and probiotic effects. InOral Health by Using Probiotic Products 2019 Aug 7. IntechOpen.
- Roberts JL, Stein AD. The impact of nutritional interventions beyond the first 2 years of life on linear growth: a systematic review and meta-analysis. Advances in Nutrition. 2017 Mar;8(2):323-36.
- Roberts M, Tolar-Peterson T, Reynolds A, Wall C, Reeder N, Rico Mendez G. The Effects of Nutritional Interventions on the Cognitive Development of Preschool-Age Children: A Systematic Review. Nutrients. 2022 Jan;14(3):532.
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