Almost 40 percent, or about 184 million, of the developing world's children under age 5 outside of China have stunted growth due to inadequate nutrition, reports a Cornell University nutritionist and statistician.

Although the worldwide prevalence of stunting is declining by about 0.5 of a percentage point each year, more than half the children in some regions of the developing world, such as Southeast Asia, are severely below the normal height for their age, says Edward Frongillo, associate professor of nutritional sciences at Cornell.

"These figures are just the tip of the iceberg. They indicate that the whole population in certain regions is not growing as well as it should be," says Frongillo, who has been researching child growth and stunting for more than 20 years.

He reported his findings to the Federation of American Societies for Experimental Biology (FASEB) in San Francisco in April in a symposium he organized on why and how stunting occurs, and in the The Third Report on the World Nutrition Situation, published by the United Nations in December 1997. The UN report used data from the World Health Organization global database on child growth and malnutrition. This is the first time that information on global and regional trends in stunting has been available.

Child growth is considered a good indicator of overall socioeconomic development and human welfare in developing countries, says Frongillo. Stunting is a physical indicator of a broad spectrum of nutritional deficiencies and is often linked to poor mental development. Stunting is a cumulative process of poor growth that primarily occurs before the age of 3 years and is not easily reversed.

"It is very disturbing that in most of the developing world, a large proportion of children are suffering from malnutrition severe enough that they are not achieving near their developmental potential," Frongillo adds.

Among the highlights of his research:

• In 1995, stunting affected 54 percent of children under 5 in South Asia, 39 percent in sub-Saharan Africa, 38 percent in Southeast Asia, 28 percent in Mexico, Central America and the Caribbean, 22 percent in the Near East and North Africa, and 13 percent in South America. In 1992, 31 percent of young children in China were stunted.
• Globally, stunted growth has declined from 49 percent of children under 5 in 1980 to 40 percent in 1995. Yet, because of an increased birthrate, the total numbers of children (excluding China) have climbed in the same period to 184 million from 176 million children.
• All the regions in the developing world except sub-Saharan Africa made some progress in reducing stunted growth among children under 5 between 1980 and 1995: From 0.9 percent reduction a year in Southeast Asia to 0.3 percent in Mexico, Central America and the Caribbean. However, stunted growth in sub-Saharan Africa climbed by 0.13 percent a year during the period. Of the 25 countries in the sub-Saharan region with data available, however, 13 made substantial progress, but in 12 countries, the rate of stunting got worse.

"We now understand that the prevalence of stunting remains high in part because it takes more than one generation for growth potential to be realized," Frongillo says. "How well a child grows depends not only on conditions after birth but also on the conditions before birth and the health and nutrition of the mother while she was growing up."

Frongillo is continuing to work with the World Health Organization to forecast the prevalence of stunting in different regions of the world 25 years from now. This information will be used to help formulate policy and planning initiatives. He is developing a survey with undergraduate honors student May Lynn Tan of Saratoga, Calif., who has just completed her junior year at Cornell. The survey is polling global experts on their predictions for how stunting trends will change in their regions. He also is conducting research to better determine what factors predispose countries to realize improvements in growth and what factors interfere with improvement.

Frongillo's research was conducted in collaboration with Francoise Vermeylen, a statistician at Cornell, and UN scientists. The 111-page report is a publication of the Administrative Coordinating Committee/Subcommittee on Nutrition of the United Nations and is available through the World Health Organization.