Planned ENN review of wasting and stunting linkages
Summary of article1
Location: Global
What we know: The relationship between wasting and stunting is under researched and poorly understood.
What this article adds: A literature review and secondary data analysis that explores the relationship between stunting and wasting will be undertaken by the ENN in 2014.
A recent ENN review of donor financing arrangements around the scale up of community based management of acute malnutrition (CMAM) highlighted a widespread misconception that acute malnutrition (or wasting) is a short term problem largely of concern to humanitarians whereas chronic malnutrition (stunting) is seen as a long term development problem.
The relationship and associations between wasting and stunting are not yet well understood. Malnutrition is a multifaceted process, resulting from a complex web of interactions, from the molecular and microbiological level of the individual, to the cultural and socioeconomic features of societies2. Acute malnutrition, manifesting as wasting or ‘thinness’, is characterised by rapid weight loss due to an acute lack of food or a period of infection. It is generally thought of as a short-term process; infrequent, temporary, and therefore a reversible state. Linear growth retardation, manifesting as stunting or ‘shortness’, is a slow, cumulative process which develops over a long period as a result of inadequate intake of nutrients, or repeated infections, or both. Stunting is more likely to be chronic and irreversible.
While both types of malnutrition may share some of the same causal pathways and are unquestionably linked, limited evidence is currently available to describe the relationship and associations between them, and whether one precedes or predisposes to the other. Additionally, almost nothing has been written on the biochemical and physiological processes through which the relationship between stunting and wasting might be both mediated and magnified.
Observations from studies to date include:
- The prevalence of wasting does not act as a good indicator for the prevalence of stunting. In many countries, children experience high levels of stunting without any wasting. A large review of 175 studies examined the associations between stunting and wasting and concluded that while there was a correlation between stunting and wasting in Asia and the Eastern Mediterranean, there was low correlation in Africa and Latin America3.
- Stunting has been shown to precede wasting in ‘small’ infants in Malawi; those born with a Low Birth Weight (LBW) as a result of Intra Uterine Growth Restriction (IUGR) are more likely to develop episodes of wasting between 6-18 months of age4. Less clear is whether wasting precedes (or predisposes) the child to becoming stunted.
- The associations between stunting and wasting in children are not consistently found in analyses using cross-sectional data5. This may be due to the short-term nature of wasting as opposed to the longer term process of stunting. In addition, wasting may precede linear growth retardation so that cross-sectional data may not demonstrate a concurrent relationship.
What is clear is that more evidence is required in order tounderstand better the complex relationships and associations between these two forms of undernutrition. Deeper understanding of changes in weight and length will mean that resources can be better targeted to combat undernutrition and reduce child mortality and eventually, pave the way for more connected programming for stunting and wasting. With this in mind, the ENN secured funding from OFDA to undertake a review of the evidence.
Research questions
The following research questions will be considered during a literature review and secondary data analyses:
- Is there an association between stunting and wasting (and vice versa) in the under-five population, i.e. does stunting predispose a child to wasting? Does untreated or repeated wasting result in a child becoming stunted? If so, how is the association mediated in the body (cellular/biological/hormonal level)?
- Is there a period of time in a child’s growth in which the interaction between stunting and wasting is most evident, i.e. in the 0-6 month age group, in the first 1000 days or in the 36-59 month age group?
- Are there regions/countries in the world where the associations between stunting and wasting (and vice versa) are more (or less) evident? What are the factors (such as epidemiological profile) which may explain these differences?
- Are there any gender differences in any of the above associations, for example, stronger relationships between wasting and stunting in male rather than female children or other associations such as birth order, wealth quintiles etc?
- How are these associations best captured, given that there is a time lag between changes in weight and height velocity (estimated at 3 months) and most surveys are cross sectional?
- Where a child is both stunted and wasted, what is the additive impact of multiple anthropometric deficits on child mortality?
- What is the evidence base for the early treatment of wasting leading to better linear growth?
- What is the evidence base for programmes that aim to reduce or prevent stunting leading to a reduced case load of wasting?
The work will be completed by the end of 2014.
For further information, contact Carmel Dolan, email: carmel@ennonline.net and Tanya Khara, email: tanya@ennonline.net
1http://www.ennonline.net/pool/files/ife/enn-cmam-financingmain-report-2013-web.pdf
2Heikens, G. T, Amadi, B. C, Manary, M, Tollins, N, and Tomkins, A (2008). Nutrition interventions need improved operational capacity. The Lancet. Published online Jan 17 2008. DOI:10.1016/S0140-6736(07)61690-0
3Victora. C. G (1992). The association between wasting and stunting: an international perspective. Journal of Nutrition (impact factor: 3.92). 06/1992; 122(5):1105-10
4Phuka. J. C et al (2012). Developmental outcomes among 18- month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour, Maternal & Child Nutrition, Volume 8, Issue 2, pages 239–248, April 2012
5Richard. S et al (2012). Wasting is associated with stunting in early childhood. J. Nutr. 142: pp 1291–1296, 2012.
More like this
FEX: Wasting is associated with stunting in early childhood
Summary of published research1 Location: Africa, Asia, Latin America What we know already: Wasting and stunting are respectively short term and longer term conditions of...
Wasting and Stunting: Overcoming the divide
Since the 1970s, those working in nutrition have categorised undernutrition in two major ways, children are either wasted or stunted. There has very rarely been consideration...
FEX: Relationships between wasting and stunting and their concurrent occurrence in Ghanaian pre-school children
Summary of research* Location: Ghana. What we know: Wasting is a short-term health issue, but repeated episodes may lead to stunting (long-term or chronic malnutrition). This...
NEX: Wasting & stunting technical interest group meeting: summary points
A meeting was convened by the ENN to discuss the evidence of the relationships between wasting and stunting and the implications that this may have for programmes and policy....
FEX: The relationship between wasting and stunting: policy, programming and research implications
Summary of review1 This summary was prepared by Tanya Khara, an independent consultant engaged by the ENN on this review. The review was made possible by the generous support...
FEX: A reflection on the 2021 Lancet Maternal & Child Nutrition Series through a WaSt lens
View this article as a pdf This article provides a summary of the Lancet Maternal & Child Nutrition Series to date, reflecting upon the 2021 series from the perspective of the...
Resource: How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? Learnings from the Wasting and Stunting Project
Abstract Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these...
FEX: The relationship between wasting and stunting in young children: A systematic review
View this article as a pdf This article was written by Susan Thurstans, PhD candidate at the London School of Hygiene and Tropical Medicine and consultant to ENN on the...
FEX: The Wasting-Stunting Technical Interest Group: A summary of the work to date
View this article as a pdf Lisez cet article en français ici This article outlines the work of the Wasting-Stunting Technical Interest Group since its inception in...
FEX: Research priorities on the relationship between wasting and stunting
Summary of research* Location: Global. What we know: There is global momentum to bring down levels of undernutrition. Wasting and stunting frequently co-exist, but are often...
Resource: 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...
FEX: WaSt Special Section Editorial
View this article as a pdf Dear readers, Our aim with this special section of Field Exchange (FEX) is to convey to you the scope of work that the Wasting and Stunting...
Blog post: Child wasting and stunting - are we where we need to be?
We've been on a high this week with the publication of the Viewpoint from the ENN coordinated Wasting-Stunting Technical Interest Group (WaSt TIG). 'Beyond wasted and...
FEX: The relationship between wasting and stunting: a retrospective cohort analysis of longitudinal data in Gambian children from 1976 to 2016
View this article as a pdf Summary of research1 Location: Gambia What we know: There are gaps in understanding the relationship between wasting and stunting that often...
FEX: Promoting linear growth when treating child wasting
View this article as a pdf This article discusses the state of evidence surrounding the treatment of wasted and stunted children considering current challenges and possible...
Resource: Research Priorities on the Relationship between Wasting and Stunting
Background Wasting and stunting are global public health problems that frequently co-exist. However, they are usually separated in terms of policy, guidance, programming and...
FEX: Livestock and nutrition: Summary of a discussion paper for the Livestock Emergency Guidelines and Standards
View this article as a pdf By Kate Sadler Dr Kate Sadler is a public nutritionist with over 20 years of experience in the design, management, evaluation and research of...
FEX: Link NCA offers a new opportunity to study drivers of concurrent wasting and stunting (WaSt)
View this article as a pdf By Lenka Blanárová and Grace Heymsfield Lenka Blanárová is Senior Nutrition Assessment Coordinator at Action Against...
FEX: Wasting and Stunting Technical Interest Group: two new publications from the research-influencing sub-working group
View this article as a pdf The research-influencing sub-working group of the Wasting and Stunting Technical Interest Group (WaSt-TIG) has recently published two papers aimed...
FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts
View this article as a pdf Lisez cet article en français ici By Zivai Murira and Harriet Torlesse Zivai Murira is Nutrition Specialist at United Nations Children's...
Reference this page
Carmel Dolan, ENN Director and Tanya Khara, ENN consultant (). Planned ENN review of wasting and stunting linkages. Field Exchange 47, April 2014. p38. www.ennonline.net/fex/47/linkages
(ENN_1079)