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Wasting and Stunting—Similarities and Differences: Policy and Programmatic Implications:

Published on Mar 1, 2015in Food and Nutrition Bulletin1.523
· DOI :10.1177/15648265150361S103
André Briend24
Estimated H-index: 24
,
Tanya Khara6
Estimated H-index: 6
,
Carmel Dolan6
Estimated H-index: 6
Sources
Abstract
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 is needed to design efficient programs. A greatly reduced muscle mass is characteristic of severe wasting, but there is indirect evidence that it also occurs in stunting. A reduced muscle mass increases the risk of death during infections and also in many other different pathological situations. Reduced muscle mass may represent a common mechanism linking wasting and stunting with increased mortality. This suggests that to decrease malnutrition-related mortality, interventions should aim at preventing both wasting and stunting, which often share common causes. Also, this suggests that treatment interventions should focus on children who are both wasted and stunted and therefore have the greatest deficits in muscle mass, instead of focusing on one or the other form of malnutrition. Interventions should also focus on young infants and children, who have a low muscle mass in relation to body weight to start with. Using mid-upper-arm circumference (MUAC) to select children in need of treatment may represent a simple way to target young wasted and stunted children efficiently in situations where these two conditions are present. Wasting is also associated with decreased fat mass. A decreased fat mass is frequent but inconsistent in stunting. Fat secretes multiple hormones, including leptin, which may have a stimulating effect on the immune system. Depressed immunity resulting from low fat stores may also contribute to the increased mortality observed in wasting. This may represent another common mechanism linking wasting and stunting with increased mortality in situations where stunting is associated with reduced fat mass. Leptin may also have an effect on bone growth. This may explain why wasted children with low fat stores have reduced linear growth when their weight-for-height remains low. It may also explain the frequent association of stunting with previous episodes of wasting. Stunting, however, can occur in the absence of wasting and even in overweight children. Thus, food supplementation should be used with caution in populations where stunting is not associated with wasting and low fat stores.
  • References (70)
  • Citations (50)
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References70
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#1Signe Marie Jensen (UCPH: University of Copenhagen)H-Index: 17
#2Christian Mølgaard (UCPH: University of Copenhagen)H-Index: 47
Last. André Briend (UTA: University of Tampere)H-Index: 20
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Nutritional status of children is commonly assessed by anthropometry both in under and overnutrition. The link between anthropometry and body fat the body compartment most affected by overnutrition is well known but the link with muscle mass the body compartment most depleted in undernutrition associated with infections remains unknown. In this study we examined the relationship between common anthropometric indices and body composition measured by dual-energy X-ray absorptiometry (DEXA) in a sa...
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#2D. Samani-Radia (London Metropolitan University)H-Index: 1
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SummaryWhat is already known about this subject Skeletal muscle is considered a major site of insulin-mediated glucose disposal and is thus a key tissue in whole-body glucose homeostasis. Low muscle mass and fitness is associated with metabolic risk and muscular strength is positively related to higher insulin sensitivity in children and adolescents. The use of skeletal muscle mass measurement in surveillance has been constrained by the absence of normative data that identifies individuals acros...
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This paper is a narrative review of the available literature on the relationship between wasting and stunting. It was born out of previous work carried out by the ENN which illustrated the divide at programme, policy and financing level between wasting and stunting. This divide ultimately has profound implications for how children worldwide receive nutrition interventions and services and, may well contribute to the lack of nutritional impact seen in programmes only addressing one part of the u...
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