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Is stunted children less prone to be wasted than normal children during emergency context?

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Frederich Christian Tan

Public Health Practitioner

Normal user

5 May 2015, 02:28

Dear experts,

In the country where I recide, we have high prevalence of stunting and low prevalence of wasting and in emergency context same is seen- high prevalence of stunting and low prevalence of wasting.

We all know that wasting is an indicator of acute malnutrition and stunting is an indicator of chronic malnutrition

Given these information, I was thinking if stunting (chronic) has some kind of inverse relationship with wasting (acute). I know the fact that these two can exist at the same time but my question is quite in different pespective.

Imagine there are two communities wherein the...

1st community: Normal children (No stunted children)
2nd community: 50% of children are stunted

Then suddenly there was a state of humanitarian crisis in both of these communities.


Which of the two will you see a higher prevalence of wasting?


(Consider this: stunted children would have lesser surface area and would require lesser energy to maintain normal weight compared to normal growing children)

Btw, I'm refering to weight-for-height for wasting not MUAC.


Hope you can enlighten me on this matter. Thank you in advance. : )

Regards,
Derich

Mark Myatt

Consultant Epideomiologist

Frequent user

6 May 2015, 08:57

Have you seen this review paper?

Frederich Christian Tan

Public Health Practitioner

Normal user

10 May 2015, 10:35

Thanks Mark. It was indeed a very interesting technical paper and it clearly shows that more efforts need to be poured to understand association between wasting and stunting. I did learn a lot from the paper that you shared.

So going back to my "theoretical" question, what can be the possible answer to this?


Mark Myatt

Consultant Epideomiologist

Frequent user

10 May 2015, 14:27

I am not sure that there is a simple answer since the interpretation of low WHZ is not universal. In (e.g.) warm-climate pastoralists we would expect low WHZ in the healthiest (least stunted) children. In this case it is body shape in the absence of pathology not pathology as is often assumed (i.e. WHZ is, for some children, not measuring "wasting" but reflecting healthy growth).

Another issue with the question is that "humanitarian crisis" is not well defined (e.g. Syria and Nepal do share similarities but are very different crises).

I agree that lower surface area (as we see in stunted children) has some "nutritional" advantage in terms of energy expenditure to maintain body temperature in cold climate. But may be disadvantageous for the same reason in warmer climates.

In any case, the stunted child starts with lower muscle mass and, with a breakdown in public health leading to increased infection (a type of / feature of a humanitarian crisis), these children would be at a disadvantage. The stunted children will likely experience higher mortality than the wasted by WHZ only children. In the light of child-survival programming the non-stunted will usually do better than the stunted children.

BTW ... defining wasting with WHZ is, I think, unique to "nutritionism". Other branches of medicine would look to loss of peripheral tissue as a defining characteristic of clinically significant "wasting".

This is probably not much help. Others (Mile, André, Carlos) may be better able to answer this question.

Frederich Christian Tan

Public Health Practitioner

Normal user

11 May 2015, 07:59

Thanks Mark. This is of great help.

André BRIEND

Frequent user

12 May 2015, 08:57

Dear Frederich,

The relation between wasting and stunting is complex and not fully understood.

The view you present, namely « We all know that wasting is an indicator of acute malnutrition and stunting is an indicator of chronic malnutrition » is rather simplistic and presumably incorrect.

There may be two different situations

In some cases, there may be an overall food / energy deficit with a high prevalence of wasting. In these situations, children are likely to have low body fat stores, and there is evidence that this can limit their growth in height. In this case, you would expect most wasted children to be stunted as well.

When the quality of diet is poor, but there is no major food/energy deficit, it looks quite plausible that children accumulate an excess of fat instead of growing in height. This at least has been observed in malnourished children receiving zinc poor diets. In that case, you may have the most stunted children having the highest weight-for-height.

Of course, you have situations where you have at the same time a problem with diet quality and quantity. Interpretation of the relationship between wasting and stunting is not easy in these cases.

We wrote recently a review on this issue that may be of interest to you. See :

Briend A, Khara T, Dolan C. Wasting and stunting--similarities and differences: policy and programmatic implications. Food Nutr Bull. 2015 Mar;36(1 Suppl):S15-23.

http://nsinf.publisher.ingentaconnect.com/content/nsinf/fnb/2015/00000036/A00101s1/art00003

By the way, MUAC is not an indicator of wasting, but of a high risk of death. Not the same thing.

I hope this helps,

Frederich Christian Tan

Public Health Practitioner

Normal user

13 May 2015, 04:39

Dear Dr. Briend,

Thank you for you reply. I read your manuscript and it is really very enlightening. Hopefully the simplistic perception of what is wasting and stunting, what is chronic and acute malnutrition, et cetera be understood by many. : )

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