Linear growth faltering and the role of weight attainment: Prospective analysis of young children recovering from severe wasting in Niger

Abstract

Efforts to reduce the impact of stunting have been largely independent of interventions to reduce the impact of wasting, despite the observation that the conditions can coexist in the same child and increase risk of death. To optimize the management of malnourished children—who can be wasted, stunted, or both—the relationship between stunting and wasting should be elaborated. We aimed to describe the relationship between concurrent weight and height gain during and after rehabilitation from severe wasting. We conducted a secondary analysis of a randomized trial for the outpatient treatment of severe wasting, including 1,542 children who recovered and were followed for 12 weeks. We described the overlap of stunting and severe wasting and the change in stunting over time. We showed the relationship between concurrent weight and height gain using adjusted generalized estimating equations and calculated the mean rate of change in weight‐for‐height z score (WHZ) and height‐for‐age z score (HAZ) during and after rehabilitation. At baseline, 79% (n = 1,223/1,542) and 49% (n = 757/1,542) of children were stunted and severely stunted, respectively. Prevalence increased over time among children <24 months. During rehabilitation when weight was not yet fully recovered, we found rapid WHZ gain but limited HAZ gain. Following successful rehabilitation, WHZ gain slowed. The rate of HAZ gain was negative after rehabilitation but increased relative to the period during treatment. The potential relationship between weight and height gain calls for increased coverage of wasting treatment to not only prevent child mortality but also reduce linear growth faltering.

Causes and consequences of child growth faltering in low- and middle-income countries

“…29,30 Individual studies have suggested that early wasting could predispose children to later linear growth failure. 43–46 We hypothesized that early wasting could contribute to subsequent linear growth restriction, and early growth failure could be consequential for persistent growth failure and mortality during the first 24 months of life. Among cohorts with monthly measurements, we examined age-stratified linear growth velocity by quartiles of WLZ at previous ages.…”

The Forgotten Agenda of Wasting in Southeast Asia: Burden, Determinants and Overlap with Stunting: A Review of Nationally Representative Cross-Sectional Demographic and Health Surveys in Six Countries

“…Both conditions should be targeted specifically, although programmatically interventions can be combined to maximize the impact. Indeed, although limited, there is evidence that stunted and wasted children respond well to treatment of wasting and that recovery from wasting may be followed by linear growth acceleration [12,48].…”

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

“…2,13,14 Wasting may also be a risk factor for stunting. 8,15,16 Research and programs often consider wasting and stunting separately, but similar risk factors underlie each condition, 17,1819 wasting may reduce linear growth, 20 and concurrent wasting and stunting heightens mortality risk far beyond the mortality risk of either condition in isolation. 3,7,8,21 The failure to implement large scale programs to prevent wasting may reflect a historic focus of programs and research on the treatment of severe wasting rather than prevention, or an incomplete understanding of the optimal time to intervene.…”