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

Abstract

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 (i.e., low weight for height, or small mid-upper arm circumference) or stunted (i.e., 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. The problem framed Child undernutrition refers broadly to the condition in which food intake does not meet the needs of physiological function, growth, and the capacity to respond to illness. Despite substantial progress in preventing and treating child undernutrition in the past three decades, approximately 5 million annual deaths in children younger than 5 years occur worldwide, 1 of which nutrition-associated factors still account for almost half of these deaths. 2 In the longer term, child undernutrition is associated with adverse effects on health and human capital. 3 The overarching strategy to address these issues is to bring together nutrition-specific interventions, targeting both mothers and their offspring in populations at risk, with nutrition-sensitive approaches that address broader underlying factors such as women's empowerment, food systems, socioeconomic factors, and disease prevention. 4 These efforts are central to Sustainable Development Goal 2.2, which aims to end all forms of malnutrition by 2030, and to reach internationally agreed targets on stunting and wasting in children under 5 years by 2025. 5 Our focus in this Viewpoint is on how the efforts to meet this goal are shaped by the way that agencies conceptualise undernutrition at the level of the individual child.

Using longitudinal data to understand nutrition and health interactions in rural Gambia

“…Finally, using time-lagged observations, we demonstrated that being wasted was predictive of subsequent stunting (Odds Ratio: 3.2; 95% Confidence Interval: 2.7, 3.9), even after accounting for current stunting (Schoenbuchner et al 2019). This analysis supports previous arguments that stunting is, in part, a biological response to previous episodes of being wasted and is important from a policy perspective as it suggests greater emphasis should be put on aligning the management of these two outcomes of undernutrition (Wells et al 2019).…”

Evaluation of the INTERGROWTH-21st project newborn standard for neonatal phenotypes and neonatal morbidity and mortality

“…These neonatal morbidity measures have been shown to be important predictors of adverse neonatal outcome, requires limited standardization of clinical diagnoses and is well accepted as a marker in large, international, population based studies of severely ill newborns (2,8) . Data from previous population-based studies indicate that the incidence of this outcome is approximately 5% (9) .…”

Combined protocol for severe and moderate acute malnutrition in emergencies: Stakeholder perspectives in four countries

“…Interventions have sometimes used the sitting height to standing height ratio (or Cormic index) to correct of weight‐for‐height measurements for the body morphology of some ethnic groups (Roberfroid et al, ; Salama et al, ), but the issue of geographical variations body shape requires further study (Briend et al, ). Evolving understandings of the frequency of multiple anthropomorphic deficits and the overlap and dynamic interactions between wasting and stunting will also influence this debate (Myatt et al, ; Wells et al, ). Although it is beyond the scope of this article to adjudicate the debate around MUAC versus WHZ, greater clarity around the specific conditions under which MUAC is an appropriate diagnostic tool, emphasizing its practicality and ease in difficult field situations, will be needed to assuage stakeholders' observed misgivings.…”