Improving height with a rational nutritional regimen

04/05/2023

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Height is determined by both genetic factors and external environmental factors, in which nutrition is the most important external factor affecting a child’s linear growth1.

Human body cells have a sophisticated sensor system, which means that only when there are enough nutrients for the body, the growth processes can occur. In other words, nutrients are the signal for growth hormone to work2 because it means that the child’s body is being provided with enough materials to build a bigger and healthier body. When children are not provided with enough nutrients, growth will be inhibited because the body will prioritize nutrients for maintaining basic metabolism process to keep the body survived over developing stature1. Besides, there are a number of vitamins and minerals that are closely related to each other in activating physiological processes to develop children’s height.

Therefore, the role of nutrition needs to be clearly understood to have appropriate and effective nutritional interventions to help optimize children’s growth. Below are some important nutritional factors for children’s height.

Nutrition is an important factor contributing to children’s height growth (Photo: istockphoto)

Energy and protein

Energy intake from macronutrients such as protein, carbohydrate and lipid helps the body have enough energy for human physiological processes to take place normally, in which protein is an important source of materials for the body. The child’s body constantly builds the musculoskeletal system to promote taller and bigger stature. Protein-energy malnutrition in Vietnam is still a matter of concern, especially in mountainous areas with a rate of 38% of children suffering from malnutrition according to the results of the National Nutrition Investigation 2019 – 2020. Protein-energy malnutrition causes children to be stunted, constrained stature development and affects their adult height. Therefore, their daily nutritional regimen needs to meet recommendations for daily energy and protein requirements in each stage of development in order to help children keep up with their growth momentum.

Age	Male energy daily requirements			Female energy daily requirements
Age	*Low PAL* *(Sedentary)*	*Medium PAL* *(Moderate)*	*High PAL* *(Vigorous)*	*Low PAL* *(Sedentary)*	*Medium PAL* *(Moderate)*	*High PAL* *(Vigorous)*
0-5 month(s)	–	550	–	–	500	–
6-8 months	–	650	–	–	600	–
9-11 months	–	700	–	–	650	–
1-2 year(s)	–	1000	–	–	930	–
3-5 years	–	1320	–	–	1230	–
6-7 years	1360	1570	1770	1270	1460	1650
8-9 years	1600	1820	2050	1510	1730	1940
10-11 years	1880	2150	2400	1740	1980	2220
12-14 years	2200	2500	2790	2040	2310	2580
15-19 years	2500	2800	3140	2110	2380	2650

Recommended energy dietary allowance (Kcal/day) for children and adolescents from 0 – 19 years old (Source: Recommended nutritional requirements for Vietnamese people 2016 – Institute of Nutrition, Ministry of Health; PAL: Physical activity level)

Age	Percentage % of energy from Protein/Total dietary energy	Protein Recommended Dietary Allowance (RDA, g/day), NPU=70%				Ratio of Animal Protein/ Total Protein (%)
		*Male*		*Female*
		g/kg/day	g/day	g/kg/day	g/day
0-5 month(s)*		1,86	11	1,86	11	100
6-8 months	13-20	2,22	18	2,22	18	>=70
9-11 months	13-20	2,22	20	2,22	20	>=70
1-2 year(s)	13-20	1,63	20	1,63	19	>=60
3-5 years	13-20	1,55	25	1,55	25	>=60
6-7 years	13-20	1,43	33	1,43	32	>=50
8-9 years	13-20	1,43	40	1,43	40	>=50
10-11 years	13-20	1,43	50	1,39	48	>=35
12-14 years	13-20	1,37	65	1,30	60	>=35
15-19 years	13-20	1,25	74	1,17	63	>=35

Recommended protein dietary allowance for children and adolescents from 0 – 19 years old (Source: Book Recommended nutritional needs for Vietnamese people 2016 – Institute of Nutrition, Ministry of Health;*AI: Adequate intake, NPU: Net protein utilize)

Calcium

Calcium is an essential mineral for bone formation in children. To develop a healthy skeletal system and attain optimal height, children and adolescents must be supplemented with calcium corresponding to the recommended dietary allowance. Suppose calcium supplementation is lacking, especially during periods when the need for calcium supplementation is high such as puberty and pre-puberty. In that case, the child’s height growth will be inhibited, and at the same time, bone mineral density will be low, increasing the risk of osteoporosis in old age.

Age	Male		Female
Age	*RDA*	UL	*RDA*	UL
0-5 month(s)	300	1000	300	1000
6-8 months	400	1500	400	1500
9-11 months	400	1500	400	1500
1-2 year(s)	500	2500	500	2500
3-5 years	600	2500	600	2500
6-7 years	650	2500	650	2500
8-9 years	700	3000	700	3000
10-11 years	1000	3000	1000	3000
12-14 years	1000	3000	1000	3000
15-19 years	1000	3000	1000	3000

Calcium RDA (mg/day) for children and adolescents from 0 – 19 years old (Source: Recommended nutritional needs for Vietnamese people 2016 – Institute of Nutrition, Ministry of Health; RDA: Recommended dietary allowance; UL: Tolerable upper intake level)

However, simply supplementing calcium from food or synthetic calcium tablets does not guarantee that the body can absorb 100% of this mineral into the blood and bones. On the other hand, if you regularly supplement calcium levels that exceed the maximum tolerance level to compensate for the amount of calcium that cannot be absorbed, there will be excess calcium amount causing kidney stones, hypercalcemia, and reduced working efficiency of kidneys and the absorption of other essential minerals such as phosphorus, zinc, magnesium, iodine, copper. So, how to optimize calcium intake without causing excess calcium? The answer lies in using it in combination with vitamins that support the absorption and transport of calcium into bones such as Vitamin D3 and Vitamin K2.

Vitamin D

In order for the body to use calcium and phosphorus well to form and maintain strong bones and teeth, children need to be supplemented with enough Vitamin D every day. The active transport mechanism of calcium relies on the activity of Calcitriol (the active form of Vitamin D) and Vitamin D receptors in the intestine. If lacking the necessary amount of Vitamin D, the body can only absorb 10 – 15% of the amount of Calcium ingested, but if enough Vitamin D is provided, the amount of Calcium absorbed from the intestines and blood will increase from 30 to 40%. Vitamin D deficiency in young children will lead to rickets and many defects in bone mineralization, causing osteomalacia, and can even cause hyperparathyroidism in adulthood. Therefore, children need to be supplemented with enough Vitamin D according to Vitamin D RDA to increase the amount of Calcium absorbed from the intestines into the blood.

Age	Male		Female
Age	*RDA*	UL	*RDA*	UL
0-5 month(s)	10	25	10	25
6-8 months	10	37,5	10	37,5
9-11 months	10	37,5	10	37,5
1-2 year(s)	15	62,5	15	62,5
3-5 years	15	75	15	75
6-7 years	15	75	15	75
8-9 years	15	100	15	100
10-11 years	15	100	15	100
12-14 years	15	100	15	100
15-19 years	15	100	15	100

Recommended need for Vitamin D (mcg/day) for children and adolescents from 0 – 19 years old (Source: Recommended nutritional needs for Vietnamese people 2016 – Institute of Nutrition, Ministry of Health; RDA: Recommended dietary allowance; UL: Upper limit)

Vitamin K2

While Vitamin D3 is necessary for the process of transporting Calcium from the intestines into the blood, Vitamin K2 is necessary for the process of transporting Calcium from the blood to the bones.

Osteoblasts will produce Osteocalcin, an important compound in the bone formation process with the task of attaching Calcium from the blood to the bone system, making bones stronger. When newly produced, osteocalcin will be in an inactive form and cannot perform the above function. To be activated and carry out its mission in the bone formation process, the body needs to be supplemented with Vitamin K2. Thanks to this mechanism, Vitamin K2 not only helps increase the amount of Calcium transported from the blood to the bones, but it also helps prevent excess calcium and deposition on blood vessel walls, the cause of many cardiovascular complications8.

Vitamin K2 (called menaquinone) is essential for the process of transporting Calcium from the blood to the bones (Photo: Freepik)

So how much Vitamin K2 per day do children need to supplement to increase the amount of Calcium in their bones? According to a study by Summeren, supplementing 45 mcg of Vitamin K2 per day in pre-pubescent children helps increase the activity of osteocalcin9, thereby increasing the amount of calcium transported from the blood to the bones, supporting height and skeletal system growth of children.

One of the foods richest in vitamin K2 is natto, a Japanese fermented soybean. However, natto has a unique flavor and many children do not like its taste. Therefore, caregivers can consider other food sources containing Vitamin K2 such as eel, cheese, beef liver or formula milk products supplemented with the trio of Calcium – Vitamin D3 – Vitamin K2 to help children optimize height and skeletal system.

Phosphorus, Magnesium, Zinc

Besides the trio of Calcium – Vitamin D3 – Vitamin K2, a number of other nutrients such as Lysine, Phosphorus, Magnesium and Zinc also contribute to height development in children.

Phosphorus is the second highest mineral in the body after calcium, playing a role in forming and maintaining strong bones and teeth. Magnesium is also necessary for a child’s skeleton quality since it integrates minerals and shapes the activity of hormones in the body. Meanwhile, zinc, as a catalyst for nearly 200 types of enzyme, also contributes to proper growth and increases the speed of height development in malnourished and stunted children7.

Below are the RDA of 3 minerals Phosphorus, Magnesium, and Zinc for children and adolescents from 0 – 19 years old.

Age	Male		Female
Age	*RDA*	UL	*RDA*	UL
0-5 month(s)	100	–	100	–
6-8 months	275	–	275	–
9-11 months	330	–	330	–
1-2 year(s)	460	–	460	–
3-5 years	500	–	500	–
6-7 years	500	–	500	–
8-9 years	500	–	500	–
10-11 years	1250	–	1250	–
12-14 years	1250	–	1250	–
15-19 years	1250	–	1250	–

Recommended needs of Magnesium (mg/day) for children and adolescents from 0 – 19 years old (Source: Recommended Nutritional Needs for Vietnamese People 2016 – Institute of Nutrition, Ministry of Health; RDA: Recommended dietary allowance; UL: Upper limit)

Age	Male			Female
Age	*EAR*	*RDA*	UL	*EAR*	*RDA*	UL
0-5 month(s)	–	40	–	–	40	–
6-8 months	–	50	–	–	50	–
9-11 months	–	60	–	–	60	–
1-2 year(s)	60	70	–	60	70	–
3-5 years	80	100	–	80	100	–
6-7 years	110	130	–	110	130	–
8-9 years	140	170	–	140	160	–
10-11 years	180	210	–	170	210	–
12-14 years	240	290	–	230	280	–
15-19 years	290	350	–	250	300	–

Age	Male			Female
	*RDA*			*RDA*
	*Poor absorption*	*Medium absorption*	*Good absorption*	*Poor absorption*	*Medium absorption*	*Good absorption*
0-5 month(s)	6,6***	2,8**	1,1*	6,6***	2,8**	1,1*
6-8 months	8,3****	4,1****	0,8* – 2,5****	8,3****	4,1****	0,8* – 2,5****
9-11 months	8,3****	4,1****	0,8* – 2,5****	8,3****	4,1****	0,8* – 2,5****
1-2 year(s)	8.3	4,1	2,4	8.3	4,1	2,4
3-5 years	9.6	4.8	2.9	9.6	4.8	2.9
6-7 years	11.2	5,6	3,3	11.2	5,6	3,3
8-9 years	12	6,0	3,3	11,2	5,6	3,3
10-11 years	17,2	8,6	5,2	14,4	7,2	4,3
12-14 years	18	9,0	6,4	16,0	8,0	4,8
15-19 years	20	10,0	6,0	16,0	8,0	4,8

Recommended needs of Zinc (mg/day) for children and adolescents from 0 – 19 years old (Source: Book of Recommended Nutritional Needs for Vietnamese People 2016 – Institute of Nutrition, Ministry of Health; RDA: Needs recommendation; UL: Maximum tolerable threshold; * Exclusively breastfed infants; ** Formula-fed infants and partially breastfed infants or low-phytate complementary foods with other milk solutions; *** Infants fed formula milk, complementary foods high in phytates and plant-based protein; **** Not applicable for exclusively breastfed infants)

Thus, height does not depend entirely on the genotype of the parents and can be optimized through good nutrition. In order to develop optimal height, children need to be supplemented with adequate and reasonable nutrition, combining macro elements (with three groups of protein, sugar, and fat) and trace elements such as Calcium, Vitamin D3 and Vitamin K2.

Parents need to accompany and support children’s nutritional regimen so that their children can develop optimal height in the first years of life. (Photo: istockphoto)

References:

Perkins JM, Subramanian SV, Davey Smith G, Özaltin E. Adult height, nutrition, and population health. Nutr Rev. 2016 Mar;74(3):149-65
Inzaghi E, Pampanini V, Deodati A, Cianfarani S. The Effects of Nutrition on Linear Growth. Nutrients. 2022 Apr 22;14(9):1752.
Judith E. Brown. “Nutrition through the life cycle” 2018
Iacona S. Maternal and child undernutrition: consequences for adult health and human capital. [ Sep; 2022 ]. 2008.
Ann Prentice et al., The effect of prepubertal calcium carbonate supplementation on the age of peak height velocity in Gambian adolescents, The American Journal of Clinical Nutrition, Volume 96, Issue 5, 2012, Pages 1042-1050, ISSN 0002-9165.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007
Viện Dinh Dưỡng – Bộ Y Tế, “Sách Nhu cầu dinh dưỡng khuyến nghị cho người Việt Nam 2016”
Maresz K. Proper Calcium Use: Vitamin K2 as a Promoter of Bone and
Cardiovascular Health. Integr Med (Encinitas). 2015 Feb;14(1):34-9.
Van Summeren, M., Braam, L., Lilien, M., Schurgers, L., Kuis, W., & Vermeer, C. (2009). The effect of menaquinone-7 (vitamin K2) supplementation on osteocalcin carboxylation in healthy prepubertal children. British Journal of Nutrition, 102(8), 1171-1178.

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Improving height with a rational nutritional regimen

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