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

Mertens A.; Benjamin-Chung J.; Colford J.M., Jr.; Hubbard A.E.; van der Laan M.J.; Coyle J.; Sofrygin O.; Cai W.; Jilek W.; Rosete S.; Nguyen A.; Pokpongkiat N.N.; Djajadi S.; Seth A.; Jung E.; Chung E.O.; Malenica I.; Hejazi N.; Li H.; Hafen R.; Subramoney V.; Häggström J.; Norman T.; Christian P.; Brown K.H.; Arnold B.F.; Abbeddou S.; Adair L.S.; Ahmed T.; Ali A.; Ali H.; Ashorn P.; Bahl R.; Barreto M.L.; Begín F.; Bessong P.O.; Bhan M.K.; Bhandari N.; Bhargava S.K.; Bhutta Z.A.; Black R.E.; Bodhidatta L.; Carba D.; Casanova I.G.; Checkley W.; Crabtree J.E.; Dewey K.G.; Duggan C.P.; Fall C.H.D.; Faruque A.S.G.; Fawzi W.W.; da Silva Filho J.Q.; Gilman R.H.; Guerrant R.L.; Haque R.; Hess S.Y.; Houpt E.R.; Humphrey J.H.; Iqbal N.T.; Jimenez E.Y.; John J.; John S.M.; Kang G.; Kosek M.; Kramer M.S.; Labrique A.; Lee N.R.; Lima A.Â.M.; Mahfuz M.; Mahopo T.C.; Maleta K.; Manandhar D.S.; Manji K.P.; Martorell R.; Mazumder S.; Mduma E.; Mohan V.R.; Moore S.E.; Mostafa I.; Ntozini R.; Nyathi M.E.; Olortegui M.P.; Petri W.A.; Premkumar P.S.; Prentice A.M.; Sachdev H.S.; Sadiq K.; Sarkar R.; Saville N.M.; Shaikh S.; Shrestha B.P.; Shrestha S.K.; Soares A.M.; Sonko B.; Stein A.D.; Svensen E.; Syed S.; Umrani F.; Ward H.D.; West K.P., Jr.; Wu L.S.F.; Yang S.; Yori P.P. · Nature (2023) · DOI: 10.1038/s41586-023-06480-z

Resumen

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.