Wasting is associated with stunting in early childhood

Abstract

The longitudinal relationship between stunting and wasting in children is poorly characterized. Instances of wasting or poor weight gain may precede linear growth retardation. We analyzed longitudinal anthropometric data for 1599 children from 8 cohort studies to determine the effect of wasting [weight-for-length Z-score (WLZ) < -2] and variability in WLZ in the first 17 mo on length-for-age Z-score (LAZ) at 18-24 mo of age. In addition, we considered the effects of change in WLZ during the previous 6-mo period on length at 18 and 24 mo. Wasting at 6-11 or 12-17 mo was associated with decreased LAZ; however, children who experienced wasting only at 0-5 mo did not suffer any long-term growth deficits compared with children with no wasting during any period. Children with greater WLZ variability (≥0.5 SD) in the first 17 mo of life were shorter [LAZ = -0.51 SD (95% CI: -0.67, -0.36 SD)] at 18-24 mo of age than children with WLZ variability <0.5. Change in WLZ in the previous 6-mo period was directly associated with greater attained length at 18 mo [0.33 cm (95% CI: 0.11, 0.54 cm)] and 24 mo [0.72 cm (95% CI: 0.52, 0.92 cm)]. Children with wasting, highly variable WLZ, or negative changes in WLZ are at a higher risk for linear growth retardation, although instances of wasting may not be the primary cause of stunting in developing countries.

FIGURE 1

Cross-sectional relationships between LAZ and WLZ by age group in combined dataset including anthropometry data collected in children <24 mo of age from 8 cohort studies. LAZ, length-for-age Z-score; WLZ, weight-for-length Z-score.

FIGURE 2

Relationship between proportion stunted at 18–24 mo and history of wasting at 0–17 mo in combined dataset including anthropometry data collected in children <24 mo of age from 8 cohort studies.

FIGURE 3

Cumulative incidence of first stunting (A) and wasting (B) measurements in combined dataset including anthropometry data collected in children <24 mo of age from 8 cohort studies.

FIGURE 4

Prevalence of wasting (percentage of measurements with WLZ < −2) by month of age in combined dataset including anthropometry data collected in children <24 mo of age from 8 cohort studies and by region, with cubic smoothing splines added to emphasize trend. Latin America includes Peru (3 studies) and Brazil, Asia includes Bangladesh and India, and Africa includes Guinea-Bissau (2 studies). WLZ, weight-for-length Z-score.

FIGURE 5

Effect of wasting in different age groups (+ indicates wasting was experienced during that period, – indicates no wasting during that period) on mean LAZ at 18–24 mo in combined dataset including anthropometry data collected in children <24 mo of age. Number of participants (n) contributing data to each category is at the top of the figure. LAZ, length-for-age Z-score.