Tibetan Children

A report appeared recently in The New England Journal of Medicine that is disturbing and interesting and then disturbing again. This far flung study was done by investigators from the University of California at Berkeley together with local health workers in Tibet. They weighed and measured and interviewed the families of 2078 Tibetan children. They found that the children were shorter than they should be and attributed that to malnutrition. They said the children's growth was "stunted." That's the disturbing part.

Some have felt, in the past, that the short stature of Tibetans was because of genetics and/or because they live at high elevations. But evidence that this represents malnutrition includes the fact that many children have signs of other nutritional deficiencies like rickets and goiter, and the infant mortality and childhood mortality is very high and their heads were smaller. Also mentioned are independent studies that show that Tibetan children, and poor children from other places, do grow as well as children from the U.S. when they have good nutrition. This is a deplorable situation and I do not doubt it.

But there is one glaring problem with this thesis that is mentioned only in passing by an editorial in the same issue of the journal - the Tibetan children are not skinny. I can also remember pictures of pudgy Tibetans. It could be that some other nutritional factor is responsible. One candidate that comes to mind is calcium and vitamin D, but the children from areas with the highest rate of rickets were taller than the children from areas with the lowest rates.

It may be that muscle mass and fat stores are guarded more strongly in the bodies of children than are height and brain growth. This is the opposite of what Pediatricians are taught. We feel that a poorly nourished child will be underweight, but height and brain growth are the last things to suffer. We need to be careful about proposing to prevent obesity by restricting the diets of children.