Peer-reviewed article
Child wasting and concurrent stunting in low- and middle-income countries
Andrew N. Mertens, Jade Benjamin‐Chung, John M Colford, Alan Hubbard, Mark J. van der Laan et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed 21 longitudinal cohorts from low- and middle-income countries to understand how child wasting develops and resolves over time. The researchers found that wasting is much more common than cross-sectional surveys suggest, affecting 29% of children by age 2 years, with peak onset between birth and 3 months. Early wasting before 6 months recovers faster but increases the risk of later growth problems and mortality. The findings suggest interventions should focus on preventing wasting from birth, particularly through improved maternal nutrition.
Key points
- By age 24 months, 29.2% of children experienced at least one wasting episode, compared to 5.6% point prevalence measured at a single time point
- Wasting incidence peaks between birth and 3 months of age
- Children wasted before 6 months recover faster but face increased risk of later growth faltering and concurrent wasting and stunting
- In populations with high seasonal rainfall, population weight-for-length varied substantially, with lowest mean Z-scores during rainiest months
- Current prevention programs targeting ages 6-59 months miss the critical period from birth to 6 months
Limitations
The study is based on secondary analysis of existing longitudinal cohorts and does not evaluate a specific intervention, so it cannot directly test what preventive strategies work. The countries represented in the 21 cohorts are not explicitly listed, limiting understanding of geographic generalizability.
Abstract
Summary Sustainable Development Goal 2.2, to end malnutrition by 2030, includes elimination of child wasting, defined as weight-for-length more than 2 standard deviations below international standards. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery, and persistence — key features that inform preventive interventions and disease burden estimates. We analyzed 21 longitudinal cohorts to show wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. By age 24 months 29.2% of children had experienced at least one wasting episode, more than 5-fold higher than point prevalence (5.6%), demonstrating that wasting affects far more children than can be inferred through cross-sectional surveys. Children wasted before 6 months had faster recovery and shorter episodes than children wasted at older ages, but early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low height-for-age), increasing their risk of mortality. In diverse populations with high seasonal rainfall, population average weight-for-length varied substantially (>0.5 z in some cohorts), with the lowest mean Z-scores during the rainiest months, creating potential for seasonally targeted interventions. Our results elevate the importance of establishing interventions to prevent wasting from birth to age 6 months, likely through improved maternal nutrition, to complement current programs that focus on children ages 6-59 months.