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CHAPTER 3 NUTRITION AND GROWTH IN THE FIRST TWO YEARS

The three sections of this chapter deal with different aspects of the effect of nutrition on growth in the first two years of life. The way in which a child follows its growth trajectory represents the most commonplace, yet fascinating, example of biological programming ( I ) . Genetic, nutritional, and emotional factors each influence the rate of growth and the final height achieved, but the extent of the relationship between the factors mediating fetal and post-natal growth rate is unclear (2,3). The practical questions arising from this are: do large babies remain on the upper percentiles for length and weight, being born with a large appetite due to hypothalamic programming in utero (3)? Or if a major influence on fetal growth rate is mediated by local maternal factors (4), do they revert after birth to another percentile channel, consistent with their genetic growth potential? Although the reverse may apply to the small babies about whom there has been most clinical interest due to practical considerations of morbidity, the factors which cause overt fetal growth impairment may be sufficiently detrimental to permanently affect somatic growth. The first section of the results concerns analysis designed to define the timing of the appearance of tracking for body mass and length, and the extent of the influence of different early nutritional experiences on this event. Overnourished children may have a supra-optimal linear growth velocity ( S ) , and there is circumstantial evidence that an excessive food intake during early infancy may be causally related to rapid somatic growth (6,7).