Acta Pœdiatr Scand 64:853-858, 1975 THE LONG-TERM EFFECTS OF PROTEIN ENERGY MALNUTRITION IN EARLY CHILDHOOD ON BONE AGE, BONE CORTICAL THICKNESS AND HEIGHT PETER J. BRIERS, JAN HOORWEG and J. PAGET STANFIELD From the Royal Inflrmary, Gloucester, Créât Brttain, the Africa Study Centre, Leyden, Netherlands and the Social Paediatric and Obstetric Research Unit, Glasgow, Scotland ABSTRACT. Briers, P. J., Hoorweg, J. C. and Stanfield, J. P. (Royal Infirmary, Gloucester, Great Britain; Africa Study Centre, Netherlands; Social Paediatric and Obstetric Research Unit, Glasgow, Scotland). The long-term effects of protein energy malnutrition m early childhood on bone âge, bone cortical thickness and height. Acta Paediatr Scand, 64:853, 1975.—Three groups of Ugandan children, 18 in each group, and one comparison group of 18 children were examined at 11-17 years of age. The three groups had previously been ad- mitted for treatment of protein energy malnutrition between the âges of 8 to 15, 16 to 21 and 22 to 27 months respectively. The comparison group had not been clinically malnour- ished thronghout the period up to 27 months of age. The children came from one tribe and from similar socio-economic background, and were individually matched on age and sex. The bone age was estimated by hand wrist radiography scored for maturity by the Tanner & Whitehouse method. The metacarpal index, a ratio derived from the medui- lary width and füll diameter of the mid-point of the second metacarpal, was used as a meas- ure of bone cortical thickness. The three malnourished groups are significantly shorter in height than the comparison group, but are not different in bone age and metacarpal index. No différences are observed between the three groups of children who had been admitted for protein energy malnutrition at different âges. The findings are discussed as they relate to the existing literature. KEY WORDS: Protein energy malnutrition, bone âge, bone cortical thickness, height s J '"•Vrotein energy malnutrition of early childhood is known to retard growth in height and bone âge but its long-term effects are less certain. Füll rehabilitation following a period of malnutrition would require complete 'catch up' skeletal growth and maturation such as would achieve the individual's genetically de- termined trajectory. It has been reported for nutritional disorders other than protein energy malnutrition that this process of 'catch up' may take up to 3 or 4 years, depending on the length and severity of the period of nutritional distortion and the adequacy of the rehabilita- tion (3, 16). In animal studies, however, McCance & Widdowson (12) have demonstrated critical periods in growth during which an induced nutritional growth falter gave rise to perma- nent deficit in size, however adequate the sub- séquent diet. Furthermore, protein energy malnutrition as it affects the infant and young child in developmg countries is far from re- sembling the closely monitored and controlled process reported in studies such as have been quoted above. The episode of ciinical malnutrition may have a fairly acute onset precipitated by infection, but this is very often preceded or followed by periods of more chronic malnutrition interspersed with further infection. Freedom from infection and dietary Acta Psdiatr Scancl 64