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

Andrew Mertens, Jade Benjamin-Chung, John M Colford Jr, 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 Hafen, Vishak Subramoney, Jonas Häggström, Thea Norman, Parul Christian, Kenneth H Brown, Benjamin F. Arnold, members of the ki Child Growth Consortium

Sustainable Development Goal 2.2.2, to end malnutrition by 2030, measures progress through elimination of child wasting, defined as weight-for-length more than 2 standard deviations below international standards. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery, and persistence — key features of wasting epidemiology that could inform preventive interventions and disease burden estimates. Here, we show through an analysis of 21 longitudinal cohorts that wasting is a highly dynamic process of onset and recovery, and incidence peaks between birth and 3 months — far earlier than peak prevalence at 12-15 months. By age 24 months 29.2% of children had experienced at least one wasting episode, more than 5-fold higher than point prevalence (5.6%), demonstrating that wasting incidence is far higher than cross-sectional surveys suggest. Children wasted before 6 months were more likely to experience concurrent wasting and stunting (low height-for-age) later, increasing their risk of mortality. In diverse populations with seasonal rainfall, population average weight-for-length varied substantially (>0.5 z in some cohorts), with the lowest mean Z-scores during the rainiest months, creating potential for seasonally targeted interventions. Our results motivate a new focus on extending preventive interventions for wasting to pregnant and lactating mothers, and for preventive and therapeutic interventions to include children below age 6 months in addition to current targets of ages 6-59 months.

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Last Updated

June, 2020