The relationship between wasting and stunting in young children: A systematic review

Abstract

In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low‐ and middle‐income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near‐term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid‐upper‐arm circumference combined with weight‐for‐age Z score might effectively identify children at most risk of near‐term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition.

Multisectoral Nutrition Interventions and Their Impact on the Nutritional Status of Children: An Open Experiment in Two Remote Blocks of Karnataka, India

“…We also studied the findings of “The relationship between wasting and stunting in young children: A systematic review” by Thurstans et al (2022), a meta-analysis of data from 45 studies from low-and-middle-income countries from 2014 to 2020. This study confines itself to the relationship between wasting and stunting only, whereas our analysis covers the relationship between wasting, stunting and underweight.…”

Linear Growth Spurts are Preceded by Higher Weight Gain Velocity and Followed by Weight Slowdowns Among Rural Children in Burkina Faso: A Longitudinal Study

“…In this analysis of the temporal relationships between individual children's length and weight growth, we find that episodes of faster ponderal growth are associated with concurrent and subsequent faster linear growth, but that episodes of faster linear growth are associated with slower future ponderal growth. Recently, the Wasting-Stunting Technical Interest Group has produced several articles and policy briefs outlining the important connections between stunting and wasting ( 38 ), and a new systematic review has confirmed the growing evidence supporting such relationships, making the case for aggregating interventions that address both forms of undernutrition ( 10 ). These papers and reports have begun to change the paradigms for addressing undernutrition ( 39 ).…”

“…Recently, increased attention has been paid to the relationships among the different forms of malnutrition, including how knowledge of interdependencies can be leveraged to increase program effectiveness ( 9 , 10 ). Several studies have shown that stunting and wasting likely have overlapping causal pathways ( 10–14 ).…”

“…Recently, increased attention has been paid to the relationships among the different forms of malnutrition, including how knowledge of interdependencies can be leveraged to increase program effectiveness ( 9 , 10 ). Several studies have shown that stunting and wasting likely have overlapping causal pathways ( 10–14 ). The consensus from studies using longitudinal data to investigate temporality between stunting and wasting is that sufficient ponderal growth, and thus ample energy reserves, may be necessary for linear growth ( 11 , 15 , 16 ).…”

Comparison of Child Undernutrition Anthropometric Indicators Across 56 Low- and Middle-Income Countries

“…Children with wasting are more likely to develop stunting, and in some places, these conditions may follow seasonal trends and environmental stressors. 10,[13][14][15][16] Generally, stunting is considered to be relatively insensitive to marginal or short-term nutritional insufficiency. In contrast, underweight and wasting may be the result of acute starvation and/or disease, but neither indicator is able to clearly differentiate between recent and chronic nutritional deficiencies.…”