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Understanding Sex Differences in Childhood Undernutrition: A Narrative Review

Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
UCL Institute for Global Health, London WC1E 6BT, UK
Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
Emergency Nutrition Network, Oxford OX5 2DN, UK
Center for Child Health Research, School of Medicine, Tampere University, 33520 Tampere, Finland
Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-2200 Copenhagen, Denmark
Brixton Health, Llwyngwril, Gwynedd LL37 2JD, Wales, UK
Institut de Recherche pour le Développement, UMI Résiliences, 93140 Bondy, France
Institut Pasteur, Epidémiologie des Maladies Emergentes, 75015 Paris, France
Senior Fellow, FERDI, Université d’Auvergne, 63000 Clermont-Ferrand, France
MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
School of Public Health, University of California, Berkeley, CA 94720-7360, USA
Maternal, Adolescent, Reproductive & Child Health Centre (MARCH), London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
Author to whom correspondence should be addressed.
Academic Editor: Aamer Imdad
Nutrients 2022, 14(5), 948;
Received: 27 January 2022 / Revised: 15 February 2022 / Accepted: 17 February 2022 / Published: 23 February 2022
(This article belongs to the Section Pediatric Nutrition)
Complementing a recent systematic review and meta-analysis which showed that boys are more likely to be wasted, stunted, and underweight than girls, we conducted a narrative review to explore which early life mechanisms might underlie these sex differences. We addressed different themes, including maternal and newborn characteristics, immunology and endocrinology, evolutionary biology, care practices, and anthropometric indices to explore potential sources of sex differences in child undernutrition. Our review found that the evidence on why sex differences occur is limited but that a complex interaction of social, environmental, and genetic factors likely underlies these differences throughout the life cycle. Despite their bigger size at birth and during infancy, in conditions of food deprivation, boys experience more undernutrition from as early as the foetal period. Differences appear to be more pronounced in more severe presentations of undernutrition and in more socioeconomically deprived contexts. Boys are more vulnerable to infectious disease, and differing immune and endocrine systems appear to explain some of this disadvantage. Limited evidence also suggests that different sociological factors and care practices might exert influence and have the potential to exacerbate or reverse observed differences. Further research is needed to better understand sex differences in undernutrition and the implications of these for child outcomes and prevention and treatment programming. View Full-Text
Keywords: undernutrition; sex; age undernutrition; sex; age
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MDPI and ACS Style

Thurstans, S.; Opondo, C.; Seal, A.; Wells, J.C.; Khara, T.; Dolan, C.; Briend, A.; Myatt, M.; Garenne, M.; Mertens, A.; Sear, R.; Kerac, M. Understanding Sex Differences in Childhood Undernutrition: A Narrative Review. Nutrients 2022, 14, 948.

AMA Style

Thurstans S, Opondo C, Seal A, Wells JC, Khara T, Dolan C, Briend A, Myatt M, Garenne M, Mertens A, Sear R, Kerac M. Understanding Sex Differences in Childhood Undernutrition: A Narrative Review. Nutrients. 2022; 14(5):948.

Chicago/Turabian Style

Thurstans, Susan, Charles Opondo, Andrew Seal, Jonathan C. Wells, Tanya Khara, Carmel Dolan, André Briend, Mark Myatt, Michel Garenne, Andrew Mertens, Rebecca Sear, and Marko Kerac. 2022. "Understanding Sex Differences in Childhood Undernutrition: A Narrative Review" Nutrients 14, no. 5: 948.

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