Acta Pediatr. Port., 1999; N.° 4; Vol. 30: 265-9 Má Nutrição Infantil: Crescimento e Amadurecimento Esquelético GLADYS E. REY (1 ), LUIS GUIMAREY (2), MARIO S. RENTERIA (3), MARIA A. RODRIGO (1 ) Hospital of Children «SSM Ludovica» La Plata Pcia Buenos Aires Argentina Summary Objective: To study longitudinal the growth and skeletal maturation (SM) in undernourished children compared with eutrophic children. Material and Method: Samples of 68 children ages 0-2 were selected from patients, primary malnourished who attend the Nutritional Rehabilitation Unit of the Children's Hospital «SSM Ludovica» in La Plata. Anthropometric evaluation and a left hand x-ray was performed upon admission and two year follow-up. The experimental population (EP) was paired by sex, age and social economic levei with an eutrophic control population (CP). Skeletal maturation (SM) was evaluated with the Greulich and Pyle Atlas (GPA). Results: First evaluation: A systematic retardation of the SM was detected in relation to the chronological ages (mean deficit 36,3%). The nutritional state was according to weight/age 46% undernourished DCP I degree, 49% DCP II degree and 5% DCP III degree; according to weight/height 13% eutrophic, 84% DCP I degree, 3% DCP II degree; according to heigth/age 14,7% eutrophic, 77,94% DCP I degree, 7,35 DCP II degree. Second evaluation: A significant difference was observed between SM and EP regarding the GPA (mean deficit 31,8%). However it showed a significant improvement between the first evalua- tion (mean deficit 36,3%) and the last (mean deficit 31,8%) (X2 = 149,422). The nutritional state according to the weight/height indicator was 46% eutrophic, 40% DCP I degree, 14% DCP II degree. According to the weight/height indicator 95% eutrophic and 5% DCP I degree. According to the height/age indicator 56,9% eutrophic, leaving 37,0% with a I degree deficit, 6,1% with a II degree deficit. The SM of the EP in relation to the CP showed significant differences in the first as well as in the second evaluation (X2 = 573,412 and 323,911 respectively). Correspondence: Gladys E. Rey Rivadavia 1210 — 1896 City Bell — Buenos Aires E_maikgrey@netverk.com.ar (1) Comission Scientific Research Pcia Buenos Aires — Nutritional Rehabi- litacion Unit. (2) Comission Scientific Research Pcia Buenos Aires — Endocrinology and Growth Unit. (3) Catedra of Medicine Infantile «B.. Subsidized: Comission Scientific Research of Prov. de Buenos Aires. Presented and approved in the XI Congress of the Latin-American Society of Nutrition (SLAN). 9-15 November 1997, Guatemala. Entregue/ para publicação em 15/06/98. Aceite para publicação em 14/10/98. Conclusions: The EP presents a deficit in height and systematic retardation of the SM which, in spite improved although significantly, it didn't reach normal leveis after two years follow- -up. The EP although had recorverd weight for height. Key-Words: Skeletal malnutrition, growth, pediatrics. Infant Malnutrition: Growth and Skeletal Maturation Introduction The retardation in growth descripted in unfavorable environmental conditions is considered by different authors as an adaptive process, interpreted as a real strategy of survival in highly poor environments where there is a high prevalence of malnutrition ('). The alteration of height is very sensible to malnutrition (2) . Different studies in Latin-America, Africa, The Philip- pines, New Guinea, India, etc. showed that around 40% of the children younger than five years of age present a retardation in growth in relation to the standards of the National Center for Health Statistics (3) of the United States, caused by malnutrition (4) and it reports an impro- vement in height in the last decades in European, American and Japanese populations with a better social economic status. A national study performed in emergency neighborhoods in the surroundings of Buenos Aires shows that 36,4% of the children 0-5 years of age present a shortage of eight (CIC-UNICEF 1988) (5). A follow-up of children with malnutrition in the Nutritional Rehabilitation Unit of the Children's Hospital in La Plata showed a disminution of height for the age (6) . The skeletal maturation is also susceptible to the environmental and genetic factos and presents greater vulnerability and risk in the periods of rapid growth such as are the first year of life and adolescence. Frisancho (7) in Peru, Dreizen (8) in Mexico, Levine (9), Pretoria Briers (18) and Keat (11) in Africa, Behar and Colb (12) and Garn (13) in Guatemala demonstrate a delay in the skeletal maturation in undernourished children in low