Complementary Health Approach Utilization Among U.S. Adults With Attention-Deficit/Hyperactivity Disorder: A Nationally Representative Survey.

Childhood stunting, a condition in which children fail to reach their genetic height potential, is a pervasive issue in countries where poverty is widespread []. The biological processes underlying stunting adversely affect childhood cognitive development and increase the risk of chronic disease development later in life []. Although height itself is not the causal determinant of poor development, serving rather as a marker for nutritional status, environmental exposures, and underlying biological processes, addressing the root causes of stunting is crucial for allowing children to reach their full developmental potential []. The critical window of intervention for stunting is typically defined as the roughly 1000‑day period between conception and 2 years of age, but children may experience catch‑up growth beyond this period, and even in the absence of catch‑up growth, developmental outcomes may still improve if the underlying causal factors resolve [, ]. Stunting has multiple levels of causation, from broader factors like poverty, healthcare infrastructure, and food systems to more immediate factors like fetal growth restriction, childhood illness, hygiene, nutritional intake, digestive health, and systemic inflammation [, ]. Prolonged poor quality of nutritional intake, even if energy needs are met, is an important contributor to stunting. Stunting is often conceptualized as representing micronutrient deficiencies, as opposed to wasting, a form of acute malnutrition that is typically understood to be caused by insufficient energy intake. However, the two conditions are related and share common causes [, ]. The World Health Organization (WHO) has released dietary guidelines for infants and young children that define what constitutes an adequate dietary intake []. It is important to note that optimal nutrient absorption requires a healthy digestive system and gut microbial ecology. Guatemala has a stunting prevalence of 46.5% among children under the age of 5, which is significantly higher than its neighbors and one of the highest in the world [, ]. The Indigenous Maya population is affected the most with the highest rates of stunting being seen in rural and predominantly Indigenous Maya areas like the departments of Quiché, Totonicapán, and Huehuetenango []. These same departments are also considered food insecurity crisis areas [], suggesting an important link between childhood stunting and food insecurity. To better address childhood stunting in Guatemala, a multifaceted approach is needed. Given the importance of nutrition, understanding the dietary patterns of children with stunting, and how closely they conform to or deviate from WHO recommendations, is helpful for developing nutrition programs that focus on the right things.