Low Intake of Calcium and Vitamin D is Associated with Stunting in 2-5-Year-Old Children from an Impoverished South African Community

Abstract

Objectives: To identify nutritional and other factors contributing to the high levels of stunting in 2-5-year-old children from an impoverished South African community where liver is frequently eaten and vitamin A deficiency known to be absent. Methods: Dietary intake was assessed by a single 24-hour recall (n=149). Heights were measured, and information was obtained on breastfeeding history, current milk intake, and substance use during pregnancy. Results: The prevalence of stunting was 36.9% and increased with age (49% in the 4-5-year-old category). Median intake of energy, carbohydrate and protein was adequate. Median intake for all micronutrients was at least 80% of the EAR, except for calcium, vitamin D and vitamin E, which was 21%, 15%, and 32%, respectively. Median intake of iron, zinc, niacin, vitamin B6 and vitamin B12 exceeded 200% of the EAR. There was a significant difference in intake of fat, calcium, phosphorous, vitamin D, riboflavin and vitamin B12 between children who were stunted and those not stunted (p<0.05). There was also a significant difference in height-for-age between children who drank milk and those who did not (p=0.004). Birth weight correlated significantly with height-for-age (r=0.250; p=0.003); birth weight was lower when mothers smoked and used alcohol during pregnancy than when they abstained (2425g vs 2961g; p<0.0001). Conclusions: Low intake of calcium and vitamin D, presumably due to inadequate milk intake after weaning, seems to significantly contribute to the high levels of stunting in this community.  Smoking and alcohol use during pregnancy, resulting in low birth weight, also seems to play an important role.