Child wasting and concurrent stunting in low- and middle-income countries

Andrew Mertens, Jade Benjamin-Chung, John M. Colford, Alan E. Hubbard, Mark J. van der Laan, Jeremy Coyle, Oleg Sofrygin, Wilson Cai, Wendy Jilek, Sonali Rosete, Anna Nguyen, Nolan N. Pokpongkiat, Stephanie Djajadi, Anmol Seth, Esther Jung, Esther O. Chung, Ivana Malenica, Nima Hejazi, Haodong Li, Ryan HafenVishak Subramoney, Jonas Häggström, Thea Norman, Parul Christian, Kenneth H. Brown, Benjamin F. Arnold, Souheila Abbeddou, Linda S. Adair, Tahmeed Ahmed, Asad Ali, Hasmot Ali, Per Ashorn, Rajiv Bahl, Mauricio L. Barreto, France Begín, Pascal Obong Bessong, Maharaj Kishan Bhan, Nita Bhandari, Santosh K. Bhargava, Zulfiqar A. Bhutta, Robert E. Black, Ladaporn Bodhidatta, Delia Carba, Ines Gonzales Casanova, William Checkley, Jean E. Crabtree, Kathryn G. Dewey, Christopher P. Duggan, Caroline H.D. Fall, Abu Syed Golam Faruque, Wafaie W. Fawzi, José Quirino da Silva Filho, Robert H. Gilman, Richard L. Guerrant, Rashidul Haque, Sonja Y. Hess, Eric R. Houpt, Jean H. Humphrey, Najeeha Talat Iqbal, Elizabeth Yakes Jimenez, Jacob John, Sushil Matthew John, Gagandeep Kang, Margaret Kosek, Michael S. Kramer, Alain Labrique, Nanette R. Lee, Aldo Ângelo Moreira Lima, Mustafa Mahfuz, Tjale Cloupas Mahopo, Kenneth Maleta, Dharma S. Manandhar, Karim P. Manji, Reynaldo Martorell, Sarmila Mazumder, Estomih Mduma, Venkata Raghava Mohan, Sophie E. Moore, Ishita Mostafa, Robert Ntozini, Mzwakhe Emanuel Nyathi, Maribel Paredes Olortegui, William A. Petri, Prasanna Samuel Premkumar, Andrew M. Prentice, Harshpal Singh Sachdev, Kamran Sadiq, Rajiv Sarkar, Naomi M. Saville, Saijuddin Shaikh, Bhim P. Shrestha, Sanjaya Kumar Shrestha, Alberto Melo Soares, Bakary Sonko, Aryeh D. Stein, Erling Svensen, Sana Syed, Fayaz Umrani, Honorine D. Ward, Keith P. West, Lee Shu Fune Wu, Seungmi Yang, Pablo Penataro Yori

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Sustainable Development Goal 2.2—to end malnutrition by 2030—includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth1. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence—key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6–59 months.

Original languageEnglish
Pages (from-to)558-567
Number of pages10
JournalNature
Volume621
Issue number7979
DOIs
Publication statusPublished - 21 Sept 2023

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