Abstract
ABSTRACTBackgroundThe etiologic relationship between wasting and stunting is poorly understood, largely because of a lack of high-quality longitudinal data from children at risk of undernutrition.ObjectivesThe aim of this study was to describe the interrelationships between wasting and stunting in children aged <2 y.MethodsThis study involved a retrospective cohort analysis, based on growth-monitoring records spanning 4 decades from clinics in rural Gambia. Anthropometric data collected at scheduled infant welfare clinics were converted to z scores, comprising 64,342 observations on 5160 subjects (median: 12 observations per individual). Children were defined as “wasted” if they had a weight-for-length z score <–2 against the WHO reference and “stunted” if they had a length-for-age z score <–2.ResultsLevels of wasting and stunting were high in this population, peaking at approximately (girls–boys) 12–18% at 10–12 months (wasted) and 37–39% at 24 mo of age (stunted). Infants born at the start of the annual wet season (July–October) showed early growth faltering in weight-for-length z score, putting them at increased risk of subsequent stunting. Using time-lagged observations, being wasted was predictive of stunting (OR: 3.2; 95% CI: 2.7, 3.9), even after accounting for current stunting. Boys were more likely to be wasted, stunted, and concurrently wasted and stunted than girls, as well as being more susceptible to seasonally driven growth deficits.ConclusionsWe provide evidence that stunting is in part a biological response to previous episodes of being wasted. This finding suggests that stunting may represent a deleterious form of adaptation to more overt undernutrition (wasting). This is important from a policy perspective as it suggests we are failing to recognize the importance of wasting simply because it tends to be more acute and treatable. These data suggest that stunted children are not just short children but are children who earlier were more seriously malnourished and who are survivors of a composite process.
Highlights
Undernutrition during the early years of life has a harmful and irreversible impact on child development and is a major influence on the risk of dying throughout life [1]
The analysis presented in this paper was funded by the United States Agency for International Development (USAID), grant ENN AID-OFDA-G15-00190, and Irish Aid
In the analysis presented here, we tested 3 broad research questions: 1) Is wasting a risk factor for stunting, and vice versa? 2) Does the season of birth influence future wasting and stunting? 3) Are there gender differences in growth deficits in the Gambia?
Summary
Undernutrition during the early years of life has a harmful and irreversible impact on child development and is a major influence on the risk of dying throughout life [1]. In the 1980s, an economist suggested that short children of adequate weight should be considered “small but healthy,” and did not merit nutritional intervention [2] This view is rejected, given evidence linking short stature with poor cognitive development in childhood, and with adult noncommunicable disease risk, but the elevated child mortality associated with stunting remains an enigma [3, 4]. Conclusions: We provide evidence that stunting is in part a biological response to previous episodes of being wasted This finding suggests that stunting may represent a deleterious form of adaptation to more overt undernutrition (wasting). This is important from a policy perspective as it suggests we are failing to recognize the importance of wasting because it tends to be more acute and treatable.
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