VIETNAM NUTRITIONAL PORTAL
Malnutrition is a condition characterized by deficiencies in protein, energy and micronutrients caused by inadequate food intake and/or illness. The term stunting is used to describe a condition in which children fail to achieve the expected height for their age and sex. It is a form of chronic malnutrition that reflects the long-term cumulative effects of undernutrition, repeated infections and other deficiencies that may persist across generations. Stunting indicates that children have not achieved their genetically determined height potential.
Stunting is considered one of the greatest obstacles to human growth and development, affecting 155 million children under five worldwide. In Vietnam, according to statistics from 2016, the prevalence of stunting among children was 24.3%, meaning that approximately one in four children under five was affected.
Factors associated with childhood stunting include low birth weight, maternal educational attainment, occupation, household economic conditions, maternal nutritional status and illnesses such as diarrhea and fever. Analyses have shown that low birth weight has a substantial influence on a child's subsequent risk of stunting. Maternal educational attainment is associated with limitations in knowledge of childcare and feeding practices.
Children from economically disadvantaged rural households face a higher risk of stunting because of limited access to adequate food. Mothers who are shorter than the average height (below 153 cm) have a higher risk of having stunted children than mothers of average height. Girls born with malnutrition may grow up to become malnourished mothers who give birth to malnourished children, perpetuating an intergenerational cycle.
Stunting is a risk factor associated with increased infant mortality, impaired health during childhood and adulthood, reduced learning ability and work productivity, and a higher risk of developing noncommunicable diseases such as diabetes and cancer later in life.
Most cases of stunting occur before the age of three and result from insufficient food intake and inadequate dietary quality. Food shortages, poverty and illness are among the direct causes of stunting.
For optimal effectiveness, interventions to prevent and control stunting should begin early, ideally during the "window of opportunity" — the first 1,000 days, from conception until a child reaches two years of age. Children have the potential to achieve their maximum height when raised in a healthy environment and provided with appropriate healthcare, nutrition services and care.
Children's height development depends on genetic and environmental factors, including nutrition and illness: Children's height development is influenced by genetics and environmental factors such as nutrition and disease. Among these, nutrition is considered the most important external factor.
It is estimated that a child's adult height will increase by an average of approximately 77 cm from their height at three years of age. The first 1,000 days of life, from pregnancy until the child reaches 24 months (two years), are considered a critical period that programs future growth and development.
Improving nutrition and complementary feeding for infants and young children are interventions that positively influence children's height. For malnourished children, supplementation with vitamin A, iron/folic acid, zinc, iodine, calcium and multiple micronutrients may be considered effective in helping them achieve catch-up growth.
Maternal nutrition has a significant influence on fetal development: Nutrition before and during pregnancy affects fetal development. Inadequate dietary intake and poor maternal nutritional status restrict fetal growth and consequently affect brain development.
Maternal malnutrition during pregnancy increases the risk of low birth weight, stunting and miscarriage. Fetal development is closely linked to maternal nutrition, and low birth weight is a major factor associated with children's mental, physical and cognitive development.
Breast milk is the ideal and best food for infants: Breast milk is the ideal and best source of nutrition for infants, with a unique composition that provides a balance of nutrients essential for optimal cellular function and growth.
Furthermore, the nutrient composition of breast milk changes to meet the nutritional needs of infants at different stages of development. Exclusive breastfeeding during the first six months of life helps improve children's health and development.
How to identify stunting in children: To determine whether a child is stunted, it is necessary to measure their recumbent length or standing height and use the World Health Organization (WHO) 2006 Child Growth Standards for children under five to assess nutritional status and the severity of malnutrition.
Recumbent length should be measured for children under 24 months of age, while standing height should be measured for children aged 24 months and older. The measurements are then compared with WHO growth standards for the corresponding age (in months).
A child is classified as stunted when their height is below the standard for children of the same age and sex (below −2 standard deviations, or −2 SD).
Children under two years of age should have their weight and length or height monitored regularly to detect early signs of growth faltering. Infants under one year should be measured once a month, while children aged one year and older should be measured every 2–3 months, preferably using growth charts to monitor their progress.
Children aged two to under five years may be measured every six months. If malnutrition is detected, weight and height measurements should be conducted monthly.
Nutrition for children with stunting: Two important aspects of caring for children with stunting are promoting optimal height development to support catch-up growth and strengthening immunity.
Stunting prevention should begin with nutritional care for mothers before and during pregnancy and continue through childbirth, breastfeeding, complementary feeding and the preschool years. Ensuring that children receive adequate nutrition according to their individual needs is the main factor influencing their potential for height development.
Before and during pregnancy, mothers should receive iron/folic acid supplements or multiple micronutrient supplements. Calcium supplementation is recommended for mothers at risk of inadequate calcium intake due to a low-calcium diet (such as those who do not consume milk or dairy products and rarely eat fish, shrimp, crab or legumes). Balanced protein and energy supplementation should also be provided, and iodized salt should be used in food preparation.
Infants should begin breastfeeding within the first hour after birth, be exclusively breastfed during the first six months and continue breastfeeding until 24 months of age or beyond.
Micronutrient supplementation should be provided to children at risk, including vitamin A supplementation for children aged 6–59 months and preventive zinc supplementation for children aged 12–59 months.
Children aged six months and older should receive appropriate complementary feeding. Their meals should include a diverse range of foods, with oils and fats as essential components, alongside animal-source protein-rich foods such as meat, eggs, shrimp, crab and fish.
The energy density of complementary foods should be increased, while their consistency can be made thinner by adding oils or fats, using bean sprouts or digestive enzymes. Fresh fruits rich in vitamins should also be included more frequently.
Consumption of calcium-rich foods such as fish, shrimp and crab should be increased. These foods can be cooked until the bones are soft enough to eat, or their shells can be crushed and the liquid strained to obtain more calcium.
Micronutrients That Influence Height Development in Children
Vitamin A, iodine and iron: Vitamin A is essential for vision, cell differentiation, immune function and bone formation. Iodine is an essential trace element for preventing goiter and severe intellectual developmental impairment.
During growth and development, the body is highly dependent on iron, which helps transport oxygen to cells throughout the body. Iron-rich foods include meat, seafood, legumes, dark green vegetables and iron-fortified foods.
Calcium: Calcium-rich foods include milk, cheese, dairy products, dark green vegetables, soy products and fish.
Recently, many calcium-fortified products have become available on the Vietnamese market, including bread, biscuits, orange juice and ready-to-eat breakfast cereals.
Calcium requirements for children are as follows:
3–5 years: 600 mg/day.
Pregnant and breastfeeding women have the highest calcium requirements, at 1,200 mg/day and 1,300 mg/day, respectively.
Children aged 3–5 years should consume four servings of milk and dairy products daily. One serving provides 100 mg of calcium, equivalent to a piece of cheese (15 g), 100 mL of yogurt (one container of yogurt), or 200 mL of liquid milk (two small glasses).
Zinc: Zinc enhances nutrient absorption, protein synthesis, cell division and appetite. Zinc deficiency can cause impaired height growth, abnormal bone development, delayed puberty, reduced reproductive function and loss of appetite due to disturbances in taste perception.
Children with prolonged poor appetite are more susceptible to malnutrition, which can eventually affect their growth and development.
Zinc also interacts with important hormones involved in bone growth. It enhances the effects of vitamin D on bone metabolism by stimulating DNA synthesis in bone cells.
Zinc-rich foods include red meat, certain types of seafood, whole grains and some zinc-fortified breakfast cereals.
Each 100 g of shellfish contains 13.4 mg of zinc, while 100 g of pork provides 5.76 mg and 100 g of beef provides 4.05 mg.
Vitamin D: Very few foods naturally contain significant amounts of vitamin D. Dietary sources include certain fish liver oils, particularly those from fatty fish, as well as the liver and fat of marine mammals (seals and polar bears), eggs from hens fed vitamin D-enriched diets, and vitamin D-fortified oils.
Each 100 g of carp contains 24.7 mcg of vitamin D, while 100 g of salmon contains 10.88 mcg, and chicken egg yolks contain 2.88 mcg per 100 g.
Vitamin D-rich foods help enhance calcium absorption, strengthen bones and support healthy growth. Children should engage in more outdoor physical activity and consume foods rich in vitamin D and calcium.
In addition to supporting height development, micronutrients also help strengthen immunity in children with stunting. These are two important aspects of helping stunted children achieve optimal height development, catch up in growth and prevent illness.
Healthy nutrition throughout the life course is essential for human growth and height development. Genetics is a major determinant of overall height, but nutrition is the key to developing healthy bones and muscles, helping children achieve their optimal height potential and preventing stunting in young children.