Child wasting and concurrent stunting in low- and middle-income countries

Nature. 2023 Sep;621(7979):558-567. doi: 10.1038/s41586-023-06480-z. Epub 2023 Sep 13.


Sustainable Development Goal 2.2-to end malnutrition by 2030-includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth1. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence-key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6-59 months.

MeSH terms

  • Cachexia* / epidemiology
  • Cachexia* / mortality
  • Cachexia* / prevention & control
  • Child, Preschool
  • Cross-Sectional Studies
  • Developing Countries*
  • Growth Disorders* / epidemiology
  • Growth Disorders* / mortality
  • Growth Disorders* / prevention & control
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Malnutrition* / epidemiology
  • Malnutrition* / mortality
  • Malnutrition* / prevention & control
  • Rain
  • Seasons