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

Author:

Mertens AndrewORCID,Benjamin-Chung JadeORCID,Colford John M.,Hubbard Alan E.ORCID,van der Laan Mark J.,Coyle JeremyORCID,Sofrygin Oleg,Cai Wilson,Jilek Wendy,Rosete Sonali,Nguyen AnnaORCID,Pokpongkiat Nolan N.ORCID,Djajadi StephanieORCID,Seth Anmol,Jung EstherORCID,Chung Esther O.,Malenica IvanaORCID,Hejazi NimaORCID,Li Haodong,Hafen RyanORCID,Subramoney Vishak,Häggström JonasORCID,Norman Thea,Christian Parul,Brown Kenneth H.,Arnold Benjamin F.ORCID,Ahmed Tahmeed,Ali Asad,Begín France,Bessong Pascal Obong,Bhutta Zulfiqar A.,Black Robert E.,Bodhidatta Ladaporn,Checkley William,Crabtree Jean E.,Das Rina,Das Subhasish,Duggan Christopher P.,Faruque Abu Syed Golam,Fawzi Wafaie W.,da Silva Filho José Quirino,Gilman Robert H.,Guerrant Richard L.,Haque Rashidul,Houpt Eric R.,Iqbal Najeeha Talat,John Jacob,John Sushil Matthew,Kang Gagandeep,Kosek Margaret,Lima Aldo Ângelo Moreira,Mahopo Tjale Cloupas,Manandhar Dharma S.,Manji Karim P.,Mduma Estomih,Mohan Venkata Raghava,Moore Sophie E.,Nyathi Mzwakhe Emanuel,Olortegui Maribel Paredes,Petri William A.,Premkumar Prasanna Samuel,Prentice Andrew M.,Rahman Najeeb,Sadiq Kamran,Sarkar Rajiv,Saville Naomi M.,Shrestha Bhim P.,Shrestha Sanjaya Kumar,Sonko Bakary,Svensen Erling,Syed Sana,Umrani Fayaz,Ward Honorine D.,Yori Pablo Penataro,

Abstract

AbstractSustainable 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.

Publisher

Springer Science and Business Media LLC

Subject

Multidisciplinary

Reference87 articles.

1. Goal 2: End Hunger, Achieve Food Security and Improved Nutrition and Promote Sustainable Agriculture (United Nations, accessed 17 August 2023); https://sustainabledevelopment.un.org/sdg2.

2. UNICEF, WHO & The World Bank Joint Child Malnutrition Estimates—Levels and Trends (UNICEF & WHO, 2023); https://data.unicef.org/resources/jme-report-2023/.

3. de Onis, M. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr. 95, 76–85 (2006).

4. Rytter, M. J. H., Kolte, L., Briend, A., Friis, H. & Christensen, V. B. The immune system in children with malnutrition—a systematic review. PLoS One 9, e105017 (2014).

5. Chang, C. Y. et al. Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery. J. Nutr. 143, 215–220 (2013).

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