Child Wasting and Concurrent Stunting in Low- and Middle-Income Countries

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Citation

Mertens, Andrew; Benjamin-Chung, Jade; Colford, John M. Jr.; Hubbard, Alan E.; van der Laan, Mark J.; Coyle, Jeremy; Sofrygin, Oleg; Cai, Wilson; Jilek, Wendy; & Rosete, Sonali, et al. (2023). Child Wasting and Concurrent Stunting in Low- and Middle-Income Countries. Nature, 621(7979), 558-567. PMCID: PMC10511327

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 growth(1). 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.

URL

http://dx.doi.org/10.1038/s41586-023-06480-z

Reference Type

Journal Article

Year Published

2023

Journal Title

Nature

Series Title

Mertens A, Benjamin-Chung J, Colford JM Jr, Hubbard AE, van der Laan MJ, Coyle J, Sofrygin O, Cai W, Jilek W, Rosete S, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Malenica I, Hejazi N, Li H, Hafen R, Subramoney V, Häggström J, Norman T, Christian P, Brown KH, Arnold BF; Ki Child Growth Consortium. Author Correction: Child wasting and concurrent stunting in low- and middle-income countries. Nature. 2023 Nov;623(7985):E1. doi: 10.1038/s41586-023-06695-0. Erratum for: Nature. 2023 Sep;621(7979):558-567. PMID: 37833391; PMCID: PMC10620077.

Author(s)

Mertens, Andrew
Benjamin-Chung, Jade
Colford, John M. Jr.
Hubbard, Alan E.
van der Laan, Mark J.
Coyle, Jeremy
Sofrygin, Oleg
Cai, Wilson
Jilek, Wendy
Rosete, Sonali
Nguyen, Anna
Pokpongkiat, Nolan N.
Djajadi, Stephanie
Seth, Anmol
Jung, Esther
Chung, Esther O.
Malenica, Ivana
Hejazi, Nima
Li, Haodong
Hafen, Ryan
Subramoney, Vishak
Häggström, Jonas
Norman, Thea
Christian, Parul
Brown, Kenneth H.
Arnold, Benjamin F.
Ki Child Growth Consortium, [
Linda Adair,
member]

Article Type

Regular

PMCID

PMC10511327

Continent/Country

LMICs

ORCiD

Chung, E - 0000-0002-2866-949X
Adair - 0000-0002-3670-8073