Abstract
The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.
Highlights
Wasting, defined by a low weight-for-height Z-score (WHZ < -2z) or mid-upper arm circumference (MUAC < 12.5cm), affected 47 million children globally in 2019
We provide evidence of a positive relationship between wasting parameters and linear growth
Our findings have underscored several points of programming and policy relevance, including 1) wasting was a contributing factor to stunting and prevention of wasting may contribute to reducing stunting in Cambodia; 2) WHZ and MUAC increases were positively correlated with accelerated linear growth suggesting wasting correction can contribute to preventing and reversing stunting; 3) Linear catch-up growth can be observed 3 to 4 months from the time of wasting correction, suggesting a need to include a post-wasting recovery follow up period in the guidelines for the management of wasting
Summary
Wasting, defined by a low weight-for-height Z-score (WHZ < -2z) or mid-upper arm circumference (MUAC < 12.5cm), affected 47 million children globally in 2019. Many countries are not on track to meet the Sustainable Development Goal (SDG) 2.2 targets to reduce the wasting prevalence to below 5% and the number of stunted children by 40% by 2025 compared to 2012 [1,2,3,4,5,6]. These two forms of undernutrition often coexist in the affected countries and communities as they share similar risk factors [7,8,9,10]. Similar findings have been documented in other countries in the region [6, 9, 12, 13]
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