Match!

The relationship between wasting and stunting: a retrospective cohort analysis of longitudinal data in Gambian children from 1976 to 2016

Published on Aug 1, 2019in The American Journal of Clinical Nutrition6.568
· DOI :10.1093/ajcn/nqy326
Simon Schoenbuchner2
Estimated H-index: 2
(Medical Research Council),
Carmel Dolan6
Estimated H-index: 6
+ 7 AuthorsSophie E. Moore40
Estimated H-index: 40
(Lond: University of London)
Abstract
Background: The 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. Objectives: The aim of this study was to describe the interrelationships between wasting and stunting in children aged <2 y. Methods: This 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. Results: Levels 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. 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 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.
  • References (30)
  • Citations (3)
📖 Papers frequently viewed together
1 Citations
1 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References30
Newest
#1Tanya KharaH-Index: 6
#2Martha Mwangome (Wellcome Trust)H-Index: 11
Last. Carmel DolanH-Index: 6
view all 4 authors...
13 CitationsSource
#1Helen M. Nabwera (Lond: University of London)H-Index: 5
#2Anthony J. C. Fulford (Lond: University of London)H-Index: 44
Last. Andrew M. Prentice (Lond: University of London)H-Index: 88
view all 4 authors...
Summary Background Growth faltering remains common in children in sub-Saharan Africa and is associated with substantial morbidity and mortality. Due to a very slow decline in the prevalence of stunting, the total number of children with stunting continues to rise in sub-Saharan Africa. Identification of effective interventions remains a challenge. Methods We analysed the effect of 36 years of intensive health interventions on growth in infants and young children from three rural Gambian villages...
26 CitationsSource
#1Kamilla G. Eriksen (Medical Research Council)H-Index: 3
#2William Johnson (Medical Research Council)H-Index: 18
Last. Sophie E. Moore ('KCL': King's College London)H-Index: 40
view all 6 authors...
Background: The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first six months of life. Objective: The objective of this study is to assess the benefit to growth of EBF to six months in a large sample of rural Gambian infants at high risk of undernutrition. Methods: Infants with growth monitoring from birth to two years of age (n=756) from the Early Nutrition and Immune Development (ENID) trial (clinical trial registry ISRCTN49285450) were categorised as exclus...
16 CitationsSource
#1Jasmine C. C. Davis (UC Davis: University of California, Davis)H-Index: 8
#2Zachery T. Lewis (UC Davis: University of California, Davis)H-Index: 11
Last. Angela M. Zivkovic (UC Davis: University of California, Davis)H-Index: 26
view all 9 authors...
Human milk oligosaccharides (HMOs) play an important role in the health of an infant as substrate for beneficial gut bacteria. Little is known about the effects of HMO composition and its changes on the morbidity and growth outcomes of infants living in areas with high infection rates. Mother's HMO composition and infant gut microbiota from 33 Gambian mother/infant pairs at 4, 16, and 20 weeks postpartum were analyzed for relationships between HMOs, microbiota, and infant morbidity and growth. T...
29 CitationsSource
#1Chloe AngoodH-Index: 2
#2Tanya KharaH-Index: 6
Last. James A. Berkley (University of Oxford)H-Index: 41
view all 4 authors...
Background Wasting and stunting are global public health problems that frequently co-exist. However, they are usually separated in terms of policy, guidance, programming and financing. Though both wasting and stunting are manifestations of undernutrition caused by disease and poor diet, there are critical gaps in our understanding of the physiological relationship between them, and how interventions for one may affect the other. The aim of this exercise was to establish research priorities in th...
16 CitationsSource
#1Branwen J. Hennig (Lond: University of London)H-Index: 26
#2Stefan Unger (Edin.: University of Edinburgh)H-Index: 6
Last. Anthony J. C. Fulford (Lond: University of London)H-Index: 44
view all 14 authors...
25 CitationsSource
#1Douglas M. BatesH-Index: 32
#2Martin MächlerH-Index: 16
Last. Steve WalkerH-Index: 2
view all 4 authors...
Maximum likelihood or restricted maximum likelihood (REML) estimates of the parameters in linear mixed-effects models can be determined using the lmer function in the lme4 package for R. As for most model-fitting functions in R, the model is described in an lmer call by a formula, in this case including both fixed- and random-effects terms. The formula and data together determine a numerical representation of the model from which the profiled deviance or the profiled REML criterion can be evalua...
14.9k CitationsSource
#1André BriendH-Index: 24
#2Tanya KharaH-Index: 6
Last. Carmel DolanH-Index: 6
view all 3 authors...
Wasting and stunting are often presented as two separate forms of malnutrition requiring different interventions for prevention and/or treatment. These two forms of malnutrition, however, are closely related and often occur together in the same populations and often in the same children. Wasting and stunting are both associated with increased mortality, especially when both are present in the same child. A better understanding of the pathophysiology of these two different forms of malnutrition i...
50 CitationsSource
Background Periodic or cyclic data of known periodicity are frequently encountered in epidemiological and biomedical research: for instance, seasonality provides a useful experiment of nature while diurnal rhythms play an important role in endocrine secretion. There is, however, little consensus on how to analysis these data and less still on how to measure association or effect size for the often complex patterns seen.
6 CitationsSource
#2Sutapa AgrawalH-Index: 23
Last. David StucklerH-Index: 53
view all 8 authors...
BACKGROUND India is the only nation where girls have greater risks of under-5 mortality than boys. We test whether female disadvantage in breastfeeding and food allocation accounts for gender disparities in mortality. METHODS AND FINDINGS Secondary, publicly available anonymized and de-identified data were used; no ethics committee review was required. Multivariate regression and Cox models were performed using Round 3 of India's National Family and Health Survey (2005-2006; response rate = 93.5...
22 CitationsSource
Cited By3
Newest
#1Rajkumar Hemalatha (ICMR: Indian Council of Medical Research)H-Index: 1
#2Anamika Pandey (Public Health Foundation of India)H-Index: 3
Last. Subodh S. Gupta (Mahatma Gandhi Institute of Medical Sciences)H-Index: 8
view all 53 authors...
Abstract Background To inform actions at the district level under the National Nutrition Mission (NNM), we assessed the prevalence trends of child growth failure (CGF) indicators for all districts in India and inequality between districts within the states. Methods We assessed the trends of CGF indicators (stunting, wasting and underweight) from 2000 to 2017 across the districts of India, aggregated from 5 × 5 km grid estimates, using all accessible data from various surveys with subnational geo...
1 CitationsSource
#1Gloria Adobea Odei Obeng‐Amoako (College of Health Sciences, Bahrain)H-Index: 1
#2Mark MyattH-Index: 20
Last. André Briend (UCPH: University of Copenhagen)H-Index: 24
view all 12 authors...
We assessed prevalence of concurrently wasted and stunted (WaSt) and explored the overlaps between wasted, stunted, underweight and low mid-upper arm circumference (MUAC) among children aged 6-59 months in Karamoja, Uganda. We also determined optimal weight-for-age (WAZ) and MUAC thresholds for detecting WaSt. We conducted secondary data analysis with 2015-2018 Food Security and Nutrition Assessment (FSNA) cross-sectional survey datasets from Karamoja. Wasting, stunting and underweight were defi...
Source
The Karlberg model of human growth describes the infancy, childhood, and puberty (ICP) stages as continuous and overlapping, and defined by transitions driven by sequential additional effects of several endocrine factors that shape the growth trajectory and resultant adult size. Previous research has suggested that a delayed transition from the infancy to the childhood growth stage contributes to sub-optimal growth outcomes. A new method developed to analyze the structure of centile crossing in ...
Source
#1Gloria Adobea Odei Obeng‐Amoako (College of Health Sciences, Bahrain)H-Index: 1
#2Henry Wamani (College of Health Sciences, Bahrain)H-Index: 17
Last. Charles A. S. Karamagi (University of Ghana)H-Index: 1
view all 10 authors...
This study assessed the prevalence of concurrently wasted and stunted (WaSt) children, their characteristics, treatment outcomes and response; and factors associated with time to recovery among children aged 6–59 months admitted to Outpatient Therapeutic Care (OTC) in Karamoja, Uganda. We conducted a retrospective cohort study with data from January 2016 to October 2017 for children admitted to nine OTCs in Karamoja. We defined wasted, stunted and underweight as 2.0 Z-scores below the median per...
1 CitationsSource
#2Estefania CustodioH-Index: 10
Last. François KayitakireH-Index: 9
view all 6 authors...
BACKGROUND: More than two decades of conflict and natural disasters in Somalia have resulted in one of the longest running humanitarian crises in the world. Nutrition data have been collected over the years despite challenges to inform programmatic action. This paper explores malnutrition and morbidity trends in Somalia during the last decade, disaggregated by geographical zone and livelihood system. METHODS: We used data from 291 cross-sectional surveys conducted in children aged 6-59 months be...
Source
#1Trenton Dailey-Chwalibóg (UGent: Ghent University)
#2Jean-François Huneau (Université Paris-Saclay)H-Index: 27
Last. Benjamin Guesdon (Action Against Hunger)H-Index: 3
view all 11 authors...
Natural abundances of stable nitrogen and carbon isotopes (δ15N and δ13C) can vary with both dietary intake and metabolic (specifically catabolic) state. In low-income countries, weaning is a period of dietary transition from milk to plant-based foods and a high-risk period for malnutrition. We explored how diet and malnutrition impact hair δ15N and δ13C in young children by an observational, cross-sectional study in Cox’s Bazar District, Bangladesh [255 children, 6–59 months with 19.6% wasted (...
Source
#1Haroldo da Silva Ferreira (UFAL: Federal University of Alagoas)H-Index: 18
BACKGROUND: The methodology currently used for nutritional assessment of populations classifies children according to four conditions: eutrophy, wasting, stunting, and overweight. However, children can be stunted and wasted concomitantly. Similarly, they can be stunted and overweight. These conditions are associated with greater susceptibility to mortality or chronic diseases, respectively. This work presents an adaptation of Waterlow's classification (AWC), which discriminates six nutritional c...
Source
#1Daniel J Raiten (NIH: National Institutes of Health)H-Index: 16
Last. Andrew A. Bremer (NIH: National Institutes of Health)H-Index: 27
view all 2 authors...
Despite a declining prevalence, stunting remains an elusive target for the global health community. The perception is that stunting represents chronic undernutrition (i.e., due to inadequate nutrient intake associated with food insecurity, low-quality diet, and suboptimal infant feeding practices in the first two years of life). However, other causes include maternal–fetal interactions leading to intrauterine growth retardation, poor maternal nutrition during pregnancy and lactation, and materna...
Source
#2Ana Lydia Sawaya (UNIFESP: Federal University of São Paulo)H-Index: 28
Last. Alessandro R DemaioH-Index: 12
view all 7 authors...
Summary Malnutrition has historically been researched and addressed within two distinct silos, focusing either on undernutrition, food insecurity, and micronutrient deficiencies, or on overweight, obesity, and dietary excess. However, through rapid global nutrition transition, an increasing proportion of individuals are exposed to different forms of malnutrition during the life course and have the double burden of malnutrition (DBM) directly. Long-lasting effects of malnutrition in early life ca...
5 CitationsSource
#1Jonathan C. K. Wells (UCL: University College London)H-Index: 62
Until recently, undernourished children were usually assessed using simple anthropometric measurements, which provide global assessments of nutritional status. There is increasing interest in obtaining more direct data on body composition to assess the effects of undernutrition on fat-free mass (FFM) and its constituents, such as muscle and organs, and on fat mass (FM) and its regional distribution. Recent studies show that severe-acute undernutrition, categorised as ‘wasting’, is associated wit...
1 CitationsSource