CHaRMS: Centre for Health Research at the Management School, Queen's University Belfast.
UKCRC Centre of Excellence for Public Health (Northern Ireland).
Int J Epidemiol. 2017 Aug 1;46(4):1171-1191. doi: 10.1093/ije/dyx017.
To understand the full impact of stunting in childhood it is important to consider the long-run effects of undernutrition on the outcomes of adults who were affected in early life. Focusing on the costs of stunting provides a means of evaluating the economic case for investing in childhood nutrition.
We review the literature on the association between stunting and undernutrition in childhood and economic outcomes in adulthood. At the national level, we also evaluate the evidence linking stunting to economic growth. Throughout, we consider randomized controlled trials (RCTs), quasi-experimental approaches and observational studies.
Long-run evaluations of two randomized nutrition interventions indicate substantial returns to the programmes (a 25% and 46% increase in wages for those affected as children, respectively). Cost-benefit analyses of nutrition interventions using calibrated return estimates report a median return of 17.9:1 per child. Assessing the wage premium associated with adult height, we find that a 1-cm increase in stature is associated with a 4% increase in wages for men and a 6% increase in wages for women in our preferred set of studies which attempt to address unobserved confounding and measurement error. In contrast, the evidence on the association between economic growth and stunting is mixed.
Countries with high rates of stunting, such as those in South Asia and sub-Saharan Africa, should scale up policies and programmes aiming to reduce child undernutrition as cost-beneficial investments that expand the economic opportunities of their children, better allowing them and their countries to reach their full potential. However, economic growth as a policy will only be effective at reducing the prevalence of stunting when increases in national income are directed at improving the diets of children, addressing gender inequalities and strengthening the status of women, improving sanitation and reducing poverty and inequities.
为了全面了解儿童发育迟缓的影响，必须考虑到在生命早期遭受营养不良的成年人的长期后果。关注发育迟缓的成本是评估投资儿童营养的经济意义的一种手段。
我们回顾了儿童期发育迟缓与成年期经济结果之间关系的文献。在国家层面，我们还评估了发育迟缓与经济增长之间联系的证据。在整个过程中，我们考虑了随机对照试验（RCT）、准实验方法和观察性研究。
对两项随机营养干预的长期评估表明，这些方案有很大的回报（受影响儿童的工资分别增加了 25%和 46%）。使用校准回报估计值对营养干预措施进行成本效益分析报告，每儿童的中位数回报为 17.9:1。评估与成人身高相关的工资溢价，我们发现，在我们首选的研究中，身高每增加 1 厘米，男性的工资就会增加 4%，女性的工资就会增加 6%，这些研究试图解决未观察到的混杂因素和测量误差。相比之下，经济增长与发育迟缓之间的关联证据是混杂的。
南亚和撒哈拉以南非洲等发育迟缓率高的国家应扩大政策和方案，旨在减少儿童营养不良，作为有益成本的投资，扩大其儿童的经济机会，使他们及其国家更好地发挥潜力。然而，经济增长作为一种政策，只有在国家收入的增加旨在改善儿童饮食、解决性别不平等问题和提高妇女地位、改善卫生条件以及减少贫困和不平等时，才能有效降低发育迟缓的流行率。
