Malnutrition, long-term health and the effect of nutritional recovery.

It is estimated that over 51 million people in Brazil live in slums, areas where a high prevalence of malnutrition is also found. In general, the population of 'slum dwellers' is growing at a faster rate than urban populations. This condition is associated with poor sanitation, unhealthy food habits, low birthweight, and stunting. Stunting is of particular concern as longitudinal and cross-sectional studies of stunted adolescents have shown a high susceptibility to gain central fat, lower fat oxidation, and lower resting and postprandial energy expenditure. In addition, higher blood pressure, higher plasma uric acid and impaired flow-mediated vascular dilation were all associated with a higher level of hypertension in low birthweight and stunted children. In particular, stunted boys and girls also showed lower insulin production by pancreatic beta cells. All these factors are linked with a higher risk of chronic diseases later in life. Among stunted adults, alterations in plasma lipids, glucose and insulin have also been reported. However, adequate nutritional recovery with linear catch-up growth, after treatment in nutritional rehabilitation centers, can moderate the alterations in body composition, bone density and insulin production.