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What are the estimated durations of untreated moderate wasting and severe wasting? Are they both still considered to be 7.5 months?

This question was posted the Management of wasting/acute malnutrition forum area and has 3 replies.

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Anonymous 24408

Normal user

6 Nov 2020, 17:54

Mark Manary

Washington University School of Medicine

Technical expert

9 Jan 2021, 03:17

This is my synthesized opinion

First CONTEXT MATTERS.  So if you are in an acute famine, treatment is more effective and death comes more quickly without treatment.  When you are in an environment with consistent high inflammation from acute infections with intermittent  improvement in the food security ( improvements NOT from treatment/ feeding), this ameliorates bad outcomes.  The latter circumstance is under appreciated as it is not a 'disaster' and the expectations of the international community are that food should just fix this type of acute malnutrition.  Many would argue this is not acute.

For SAM I would say 50% die before 3mo and 10% seem to survive for years.

For MAM, I just completed a new study on the natural history of MAM without feeding, and instead of dying, a poor outcome is much more likely to be SAM.  35% will develop SAM by 6mo and sponteneous recovery will be seem in 35%.  So I would say that after 4 mo half of MAM children 'declare themselves' for better or worse.

What type of context do you work in?


Technical expert

12 Jan 2021, 11:30

Hi Anonymous,

You may find the following paper by Isanaka et al. interesting reading,

Echoing what Mark has already said the authors state:

"The duration of untreated episodes of acute malnutrition will probably vary geographically and temporally depending on a number of contextual factors, such as the severity and type of malnutrition (kwashiorkor vs. marasmus), the prevalence of infectious illness, access to health services, and the age structure of the population. As a result, a single estimate of average duration is not likely to apply to all settings."

Also see:

I hope this helps,


Cecile Basquin

Nutrition Cluster Coordinator

Normal user

29 Jan 2021, 14:28

Dear Mark,

Many thanks for sharing on this. Is this recent study you're refering to available? I would be very interested to learn more on these interesting findings.

Many thanks,


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