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

Andrew Mertens (), Jade Benjamin-Chung, John M. Colford, Alan E. Hubbard, Mark J. 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 Hafen, Vishak Subramoney, Jonas Häggström, Thea Norman, Parul Christian, Kenneth H. Brown and Benjamin F. Arnold ()
Additional contact information
Andrew Mertens: University of California, Berkeley
Jade Benjamin-Chung: University of California, Berkeley
John M. Colford: University of California, Berkeley
Alan E. Hubbard: University of California, Berkeley
Mark J. Laan: University of California, Berkeley
Jeremy Coyle: University of California, Berkeley
Oleg Sofrygin: University of California, Berkeley
Wilson Cai: University of California, Berkeley
Wendy Jilek: University of California, Berkeley
Sonali Rosete: University of California, Berkeley
Anna Nguyen: University of California, Berkeley
Nolan N. Pokpongkiat: University of California, Berkeley
Stephanie Djajadi: University of California, Berkeley
Anmol Seth: University of California, Berkeley
Esther Jung: University of California, Berkeley
Esther O. Chung: University of California, Berkeley
Ivana Malenica: University of California, Berkeley
Nima Hejazi: University of California, Berkeley
Haodong Li: University of California, Berkeley
Ryan Hafen: Hafen Consulting
Vishak Subramoney: DVPL Tech
Jonas Häggström: Cytel
Thea Norman: Bill & Melinda Gates Foundation
Parul Christian: Johns Hopkins Bloomberg School of Public Health
Kenneth H. Brown: University of California, Davis
Benjamin F. Arnold: University of California

Nature, 2023, vol. 621, issue 7979, 558-567

Abstract: 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.

Date: 2023
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DOI: 10.1038/s41586-023-06480-z

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