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Beyond wasted and stunted—a major shift to fight child undernutrition

Published on Nov 1, 2019in The Lancet Child & Adolescent Health
· DOI :10.1016/S2352-4642(19)30244-5
Jonathan C. K. Wells62
Estimated H-index: 62
(UCL: University College London),
André Briend24
Estimated H-index: 24
(UCPH: University of Copenhagen)
+ 6 AuthorsCarmel Dolan6
Estimated H-index: 6
(UCL: University College London)
Sources
Abstract
Summary Child undernutrition refers broadly to the condition in which food intake is inadequate to meet a child's needs for physiological function, growth, and the capacity to respond to illness. Since the 1970s, nutritionists have categorised undernutrition in two major ways, either as wasted (ie, low weight for height, or small mid-upper arm circumference) or stunted (ie, low height for age). This approach, although useful for identifying populations at risk of undernutrition, creates several problems: the focus is on children who have already become undernourished, and this approach draws an artificial distinction between two idealised types of undernourished children that are widely interpreted as indicative of either acute or chronic undernutrition. This distinction in turn has led to the separation of programmatic approaches to prevent and treat child undernutrition. In the past 3 years, research has shown that individual children are at risk of both conditions, might be born with both, pass from one state to the other over time, and accumulate risks to their health and life through their combined effects. The current emphasis on identifying children who are already wasted or stunted detracts attention from the larger number of children undergoing the process of becoming undernourished. We call for a major shift in thinking regarding how we assess child undernutrition, and how prevention and treatment programmes can best address the diverse causes and dynamic biological processes that underlie undernutrition.
  • References (25)
  • Citations (3)
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References25
Newest
#1Simon Schoenbuchner (Medical Research Council)H-Index: 2
#2Carmel DolanH-Index: 6
Last. Sophie E. Moore (Lond: University of London)H-Index: 40
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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 sched...
3 CitationsSource
#1Moses Ngari (Wellcome Trust)H-Index: 9
#2Per Ole IversenH-Index: 34
Last. James A. BerkleyH-Index: 41
view all 7 authors...
Background Stunting is the most common manifestation of childhood undernutrition worldwide. Children presenting with severe acute malnutrition (SAM) are often also severely stunted. We evaluated linear growth and its determinants after medically complicated SAM. Methods We performed secondary analysis of clinical trial data ( NCT00934492) from HIV-uninfected Kenyan children aged 2–59 months hospitalised with SAM. Outcome was change in height/length-for-age z-score (HAZ) between enrolment and 12 ...
1 CitationsSource
#1Jonathan C. K. Wells (ICH: UCL Institute of Child Health)H-Index: 62
#2Delan Devakumar (UCL Institute for Global Health)H-Index: 4
Last. David Osrin (UCL Institute for Global Health)H-Index: 10
view all 7 authors...
Stunting remains a very common form of child malnutrition worldwide, particularly in South Asian populations. There is poor understanding of how it develops and how it is associated with subsequent phenotype. We used data from a longitudinal cohort of children (n = 841) in lowland Nepal to investigate associations of stunting at 2 years with maternal traits and early growth patterns, and with body size and composition, kidney dimensions by ultrasound, lung function by spirometry and blood pressu...
2 CitationsSource
#1Jean Hawes Humphrey (Johns Hopkins University)H-Index: 9
#2Mduduzi N N MbuyaH-Index: 15
Last. Talent MakoniH-Index: 1
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Summary Background Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. Methods We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Mi...
31 CitationsSource
Background Using mid-upper arm circumference (MUAC) to identify severe acute malnutrition (SAM) tends to identify younger and stunted children compared to alternative anthropometric case-definitions. It has been asserted by some experts, without supporting evidence, that stunted children with low MUAC may have normal weight for height and treatment with ready to use therapeutic food (RUTF) will cause excess adiposity, placing the child at risk for non-communicable diseases (NCD) later in life. I...
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#1Jessica FanzoH-Index: 26
#2Corinna HawkesH-Index: 43
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The 2018 Global Nutrition Report shares insights into the current state of global nutrition, highlighting the unacceptably high burden of malnutrition in the world. It identifies areas where progress has been made in recent years but argues that it is too slow and too inconsistent. It puts forward five critical steps that are needed to speed up progress to end malnutrition in all its forms and argues that, if we act now, it is not too late to achieve this goal. In fact, we have an unprecedented ...
28 Citations
#1Mark MyattH-Index: 20
#2Tanya KharaH-Index: 6
Last. André Briend (UCPH: University of Copenhagen)H-Index: 24
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Background Wasting and stunting are common. They are implicated in the deaths of almost two million children each year and account for over 12% of disability-adjusted life years lost in young children. Wasting and stunting tend to be addressed as separate issues despite evidence of common causality and the fact that children may suffer simultaneously from both conditions (WaSt). Questions remain regarding the risks associated with WaSt, which children are most affected, and how best to reach the...
5 CitationsSource
#1Kassandra L. Harding (Yale University)H-Index: 1
#2Víctor M. Aguayo (UNICEF)H-Index: 16
Last. Patrick Webb (Tufts University)H-Index: 32
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South Asia continues to carry the greatest share and number of wasted children worldwide. Understanding the determinants of wasting is important as policymakers renew efforts to tackle this persistent public health and development problem. Using data from national surveys in Bangladesh, India, the Maldives, Nepal, Pakistan and Afghanistan, this analysis explores factors associated with wasting among children aged 0 to 59 months (n = 252,797). We conducted multivariate mixed logistic regression a...
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#1Mathias Altmann (Action Against Hunger)H-Index: 2
#2Chiara Altare (Action Against Hunger)H-Index: 3
Last. Patrick Kolsteren (UGent: Ghent University)H-Index: 41
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Abstract. Water, sanitation and hygiene (WASH) interventions have a small but measurable benefit on stunting, but not on wasting. Our objective was to assess the effectiveness of a household WASH package on the performance of an Outpatient Therapeutic feeding Program (OTP) for severe acute malnutrition (SAM). We conducted a cluster-randomized controlled trial embedded in a routine OTP. The study population included 20 health centers (clusters) from Mao and Mondo districts in Chad. Both arms rece...
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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...
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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...
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#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...
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