MALNUTRITION-INDUCED GROWTH FAILURE IN CHILDREN: A GLOBAL NARRATIVE REVIEW OF BIOCHEMICAL MECHANISMS AND CLINICAL IMPLICATIONS

Abstract

Malnutrition remains a major global public health challenge and a leading cause of growth failure among children, particularly in low- and middle-income countries. Although its clinical manifestations such as stunting and wasting are well recognized, the underlying biochemical mechanisms remain fragmented across endocrine, metabolic, immunological, and nutritional domains. This lack of integrated understanding limits advances in targeted diagnosis and treatment. This review therefore aimed to synthesize current evidence on the biochemical mechanisms underlying malnutrition-induced growth failure in children. A narrative review design guided by the PRISMA 2020 framework was adopted to ensure a systematic and transparent approach to literature identification, screening, eligibility assessment, and inclusion. A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Google Scholar, supplemented by manual searches of reference lists. The review found that malnutrition-induced growth failure results from multiple interacting biochemical pathways. Central to this process is disruption of the growth hormone–insulin-like growth factor-1 (GH–IGF-1) axis, characterized by growth hormone resistance and reduced IGF-1 synthesis. Protein and energy malnutrition were associated with increased proteolysis, negative nitrogen balance, muscle wasting, and impaired tissue development. Micronutrient deficiencies, including iron, zinc, iodine, and vitamin D, were shown to impair enzymatic activity, endocrine regulation, and skeletal growth.  Malnutrition-induced growth failure is a complex systemic biochemical disorder involving endocrine, metabolic, immune, and oxidative stress pathways. Effective management requires integrated strategies that go beyond caloric supplementation to include micronutrient correction, infection control, and inflammation reduction.