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The determinants of undernutrition are well documented and have been recently updated to incorporate all forms of malnutrition [2]. Immediate causes include health-related behaviors (e.g., diet, activity, hygiene) and biological factors (e.g., disease state, genetics). Underlying these are several household- and community-level factors that facilitate or limit a household’s ability to provide health, care, and a quality diet, such as access to food and health care, social norms related to care and feeding, and the living environment (e.g., built spaces and water and sanitation services). These factors are in turn affected by income and inequality, trade, urbanization, existence of social protection and health systems, and agricultural development, among other factors. Finally, the extent to which such factors may favor nutrition depends on an enabling environment of political commitment, effective governance, and capacity. As illustrated above in the case of Brazil, progress to address malnutrition has typically been better when policies and programs address such determinants simultaneously, accompanied by economic growth [2].

Fig. 3. Conceptual framework on the determinants of child growth. Developed by the authors building on previously published frameworks [27, 28]. IUGR, Intra-uterine growth retardation; NCDs, Non-communicable diseases.