Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Jan;10(1):22-38.
doi: 10.1016/S2352-4642(25)00303-7.

Quantifying the fatal and non-fatal burden of disease associated with child growth failure, 2000-2023: a systematic analysis from the Global Burden of Disease Study 2023

GBD 2023 Child Growth Failure Collaborators
Collaborators, Affiliations

Quantifying the fatal and non-fatal burden of disease associated with child growth failure, 2000-2023: a systematic analysis from the Global Burden of Disease Study 2023

GBD 2023 Child Growth Failure Collaborators. Lancet Child Adolesc Health. 2026 Jan.

Abstract

Background: Child growth failure (CGF), which includes underweight, wasting, and stunting, is among the factors most strongly associated with mortality and morbidity in children younger than 5 years worldwide. Poor height and bodyweight gain arise from a variety of biological and sociodemographic factors and are associated with increased vulnerability to infectious diseases. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to estimate CGF prevalence, the risk of infectious diseases associated with CGF, and the disease mortality, morbidity, and overall burden associated with CGF.

Methods: In this analysis we estimated the all-cause and cause-specific (diarrhoea, lower respiratory tract infections, malaria, and measles) disability-adjusted life-years (DALYs) lost and mortality associated with stunting, wasting, underweight, and CGF in aggregate. We combined the burden associated with mild, moderate, and severe forms of CGF: stunting was defined as height-for-age Z scores (HAZ) less than -1, underweight was defined as weight-for-age Z scores (WAZ) less than -1, and wasting was defined as weight-for-height Z scores (WHZ) less than -1, according to WHO Child Growth Standards. Population-level continuous distributions of HAZ, WAZ, and WHZ were estimated for 2000 to 2023 using data from surveys, literature, and individual-level study data. The risk of incidence of, and mortality due to, diarrhoea, lower respiratory infections, malaria, and measles was separately estimated in a meta-regression framework from longitudinal cohort data for Z scores less than -1. Finally, fatal outcomes associated with these diseases were estimated with vital registration, verbal autopsy, and case-fatality data, while non-fatal outcomes were estimated with surveys as well as health-care utilisation and case reporting data. The exposure prevalence and relative risk estimates were from continuous distributions, allowing for direct assessment of the attributable fractions for mild, moderate, and severe stunting, underweight, wasting, and the combined impact of child growth failure within populations. All estimates were age-specific, sex-specific, geography-specific, and year-specific.

Findings: We estimated that, in children younger than 5 years in 2023, CGF was associated with 79·4 million (95% uncertainty interval [UI] 47·0-106) DALYs lost and 880 000 (517 000-1 170 000) deaths. This represented 17·9% (10·6-23·8) of 444 million (434-457) total under-5 DALYs and 18·8% (11·1-25·0) of all 4·67 million (4·59-4·75) under-5 deaths. Compared to stunting (33·0 million [24·1-42·2] DALYs, 373 000 [272 000-477 000] deaths) and wasting (39·2 million [23·8-53·0] DALYs, 428 000 [256 000-583 000] deaths), childhood underweight was associated with the largest share of CGF-related disease burden: 52·2 million (21·9-75·1) DALYs and 573 000 (236 000-824 000) deaths in children younger than 5 years in 2023.

Interpretation: CGF remains a leading factor associated with death and disability in children younger than 5 years, despite global attention and focused interventions to reduce the prevalence of associated CGF indicators. Our findings underscore the need for policies, strategies, and interventions that focus on all indicators of CGF to reduce its associated health burden.

Funding: Gates Foundation.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests S Afzal reports support for the present manuscript from the Institute of Public Health Lahore; grants or contracts from the Dean office Institute of Public Health Lahore; honoraria for experts, lectures, visiting speakers, and educational seminars provided by the Dean Institute of Public Health Lahore; support for attending meetings and travel provided by the Dean Institute of Public Health, Lahore Pakistan; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as a Member of the Pakistan Higher Education Commission Research Committee, Member of Pakistan Medical and Dental Commission Research and Journals Committee, Member of Pakistan National Bioethics Committee, Member of Pakistan Society of Internal Medicine, Member of Pakistan Association of Medical Editors, Member of Medical Microbiology and Infectious Diseases Society, a Fellow of LEADS International, Fellow of Faculty of Public Health UK, and as a Fellow of College of Physicians and Surgeons Pakistan; receipt of equipment, materials, drugs, and services including computer software and equipment from Bergen University Norway for research writing; and other financial or non-financial support from the Dean Public Health Institute of Public Health Birdwood Lahore, outside the submitted work. J Baker reports grants or contracts paid to her institution from Novo Nordisk Foundation, World Cancer Research Fund, Independent Research Council Denmark, and European Union Horizon; consulting fees from Novo Nordisk; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novo Nordisk; support for attending meetings or travel, or both, from the European Association for the Study of Obesity; participation on a data safety monitoring board or advisory board from Novo Nordisk; and leadership or fiduciary roles in other board, society, committee, or advocacy groups, paid or unpaid with the European Association for the Study of Obesity, outside the submitted work. M L Bell reports grants or contracts paid to her institution from the US Environmental Protection Agency, National Institutes of Health, Hutchinson Postdoctoral Fellowship, Health Effects Institute, Robert Wood Johnson Foundation, Wellcome Trust Foundation, and Internal Yale funding for the Yale Institute for Biospheric Studies; consulting fees from Clinique and Toximap; honoraria for speaking from the Colorado School of Public Health, Duke University, University of Texas, Data4Justice, Korea University, UPenn, Brown University, and Northeastern University; honorarium for editorial duties from IOP Publishing; honorarium for grant review from the NIH, Health Canada, Environment, Health & Safety, Program Advisory Committee, UK Research and Innovation, AXA Research Fund Fellowship, and University of Texas; honorarium for research from Korea University; honoraria for participation on an external advisory committee from Harvard University and University of Montana; honorarium for online survey or workshop from SciQuest; support for attending meetings or travel, or both, from the Colorado School of Public Health, University of Texas, Duke University, Harvard University, American Journal of Public Health, Columbia University, Harvard, Community Modeling and Analysis System conference, Nature Conference, Boston University, and Northeastern University; leadership or fiduciary roles in other board, society, committee, or advocacy groups, paid or unpaid from the Fifth National Climate Assessment, Lancet Countdown, US EPA Clean Air Scientific Advisory Committee (CASAC), Johns Hopkins Department of Environmental Health And Engineering Advisory Board, Harvard external advisory committee for training grant, WHO Global Air Pollution and Health Technical Advisory group, and the National Academies Panels and Committees, outside the submitted work. S Bhaskar reports grants or contracts from the Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), Grant-in-Aid for Scientific Research (KAKENHI; Grant ID 23KF0126), JSPS and the Australian Academy of Science, JSPS International Fellowship (Grant ID P23712); leadership or fiduciary roles in other board, society, committee, or advocacy groups, paid or unpaid as District Chair, Diversity, Equity, Inclusion & Belonging of Rotary District 9675 (Sydney, Australia); as Chair, Founding Member, and Manager of the Global Health & Migration Hub Community, Global Health Hub Germany (Berlin, Germany); as Editorial Board Member of PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research, Neurology International, Diagnostics, and BMC Medical Research Methodology; as a member of the College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada; as the Director of Research of World Headache Society (Bengaluru, India), as Expert Adviser/Reviewer of Cariplo Foundation (Milan, Italy), as Visiting Director of National Cerebral and Cardiovascular Center, Department of Neurology, Division of Cerebrovascular Medicine and Neurology, Suita (Osaka, Japan); as Member, Scientific Review Committee of Cardiff University Biobank (Cardiff, UK), as Chair of Rotary Reconciliation Action Plan, and Healthcare and Medical Adviser at Japan Connect (Osaka, Japan), outside the submitted work. A A Fomenkov reports support for the present manuscript from the Ministry of Science and Higher Education of the Russian Federation (theme number 122042600086-7 and number 122042700043-9). N J Kassebaum reports support for the present manuscript from the Gates Foundation (funding for Global Burden of Disease Study); consulting fees from Fujifilm Sonosite (product development consultation unrelated to present work) and Philips (product development consultation unrelated to present work); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Bristol Myers Squibb (travel expenses plus consulting fees for presenting GBD results at international meeting). K Krishan reports other financial or non-financial interests from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University (Chandigarh, India), outside the submitted work. J Liu reports support for the present manuscript and grants from the National Natural Science Foundation (72474005) and Beijing Natural Science Foundation (L222027). L Monasta reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. S Nomura reports support for the present manuscript from the Ministry of Education, Culture, Sports, Science and Technology of Japan (24H00663) Grant and the Precursory Research for Embryonic Science and Technology from the Japan Science and Technology Agency (JPMJPR22R8) Grant. Y L Samodra reports grants or contracts from Taipei Medical University (Taiwan), Type A Doctoral Scholarship, Institute of Epidemiology and Preventive Medicine, National Taiwan University, National Science and Technology Council Taiwan, Post-doctoral Fellow contract; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Generasi Peneliti, Indonesia; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as the co-founder of Benang Merah Research Center, Indonesia (https://www.benangmerah.net); and other financial or non-financial interests as a scholarship mentor with Jago Beasiswa (https://www.idebeasiswa.com), outside the submitted work. V Sharma acknowledges support from Directorate of Forensic Science, Ministry of Home Affairs research project (DFSS28(1)2019/EMR/6) at the Institute of Forensic Science & Criminology, Panjab University (Chandigarh, India), outside the submitted work. L M L R da Silva reports grants or contracts from SPRINT (Sport Physical Activity and Health Research & Innovation Center), Polytechnic of Guarda (6300-559 Guarda, Portugal) and RISE-Health, Faculty of Health Sciences, University of Beira Interior (6201-506 Covilhã, Portugal), outside the submitted work. J Singh reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, ANI/Exeltis, USA Inc, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs, Adept Field Solutions, Clinical Care Options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point Communications; and the NIH; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings or travel, or both, from Simply Speaking; leadership or fiduciary roles in other board, society, committee, or advocacy groups, paid or unpaid as a past steering committee member of OMERACT, an international organization that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, and as Chair of the Veterans Affairs Rheumatology Field Advisory Committee, and as editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis; stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, Aebona Pharmaceuticals, and Charlotte's Web Holdings; and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals, outside the submitted work. J H V Ticoalu reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as Co-founder of Benang Merah Research Center, Indonesia (https://www.benangmerah.net), outside the submitted work. M Titova reports support for the present manuscript from the state assignment of the Ministry of Science and Higher Education of the Russian Federation (theme number 122042600086-7 and number 122042700043-9). E Upadhyay reports the following patents planned, issued or pending with The Office of the Controller General of Patents, Designs & Trade Marks (CGPDTM; https://iprsearch.ipindia.gov.in/PublicSearch/PublicationSearch/ApplicationStatus): “Eco-friendly bio-shoe polish from banana and turmeric” (filed 202511021382), “Honey-based polyherbal syrup composition to treat air pollution-induced inflammation and preparation method thereof” (filed 202511035171), “Process for preparing a caffeine free, antioxidant and nutrient rich beverage” (filed 202511042794), “A system and method of reusable filters for anti-pollution mask” (published 202011003559), “A system and method for electricity generation through crop stubble by using microbial fuel cells” (published 202011008531), “A system for disposed personal protection equipment (PPE) into biofuel through pyrolysis and method” (published 202111005659), “A novel herbal pharmaceutical aid for formulation of gel and method thereof” (published 202111023333), “Herbal drug formulation for treating lung tissue degenerated by particulate matter exposure” (published 202311035276), “A method to transform cow dung into the wall paint by using natural materials and composition thereof” (filed 202311085452), “Biodegradable packaging composition and method of preparation thereof” (filed 202511017848); and leadership or fiduciary roles in other board, society, committee, or advocacy groups as an Executive Council Member for the Indian Meteorological Society, Jaipur Chapter (India) and a Member Secretary for the Department of Science & Technology (DST), Promotion of University Research and Scientific Excellence (PURSE) Program, outside the submitted work.

Figures

Figure 1
Figure 1
Global burden associated with child growth failure for children younger than 5 years as a fraction of all deaths (A), number of attributable deaths (B), and attributable mortality rate per 100 000 (C) Separate panels show the attributable burden for underweight, wasting, and stunting separately, as well as child growth failure as a whole. Shaded regions represent 95% uncertainty intervals. Estimates combine burden associated with mild, moderate, and severe forms of child growth failure: stunting was defined as height-for-age Z score (HAZ) less than –1; underweight was defined as weight-for-age Z score (WAZ) less than –1; and wasting was defined as weight-for-height Z score (WHZ) less than –1, according to WHO Child Growth Standards.
Figure 2
Figure 2
Percentage of all-cause deaths and years lived with disability associated with all child growth failure (mild, moderate, and severe) in children younger than 5 years, globally, in 2023 Population attributable fraction of all-cause deaths and years lived with disability for all children younger than 5 years, as well as age-specific values (1 to <6 months, 6 to <12 months, 12 to <24 months, and 24 to<60 months) are plotted. Dots represent mean population attributable fractions and whiskers represent 95% uncertainty intervals.
Figure 3
Figure 3
Deaths from all child growth failure (mild, moderate, and severe) in children younger than 5 years per 100 000 in 2023 CGF=child growth failure.
See this image and copyright information in PMC

References

    1. Bhutta ZA, Berkley JA, Bandsma RHJ, Kerac M, Trehan I, Briend A. Severe childhood malnutrition. Nat Rev Dis Primers. 2017;3:17067. - PMC - PubMed
    1. GBD 2019 Risk Factors Collaborators Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223–1249. - PMC - PubMed
    1. Olofin I, McDonald CM, Ezzati M, et al. and the Nutrition Impact Model Study (anthropometry cohort pooling) Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies. PLoS One. 2013;8:e64636. - PMC - PubMed
    1. Black RE, Victora CG, Walker SP, et al. and the Maternal and Child Nutrition Study Group Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–451. - PubMed
    1. McDonald CM, Olofin I, Flaxman S, et al. and the Nutrition Impact Model Study The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. Am J Clin Nutr. 2013;97:896–901. - PubMed

LinkOut - more resources