Andrew Mertens, Jade Benjamin-Chung, John M. Colford, Alan E. Hubbard, Mark J. van der Laan, Jeremy Coyle, Oleg Sofrygin, Wilson Cai, Wendy Jilek, Sonali Rosete, Anna Nguyen, Nolan N. Pokpongkiat, Stephanie Djajadi, Anmol Seth, Esther Jung, Esther O. Chung, Ivana Malenica, Nima Hejazi, Haodong Li, Ryan Hafen, Vishak Subramoney, Jonas Häggström, Thea Norman, Parul Christian, Kenneth H. Brown, Benjamin F. Arnold, Souheila Abbeddou, Linda S. Adair, Tahmeed Ahmed, Asad Ali, Hasmot Ali, Per Ashorn, Rajiv Bahl, Mauricio L. Barreto, France Begín, Pascal Obong Bessong, Maharaj Kishan Bhan, Nita Bhandari, Santosh K. Bhargava, Zulfiqar A. Bhutta, Robert E. Black, Ladaporn Bodhidatta, Delia Carba, Ines Gonzales Casanova, William Checkley, Jean E. Crabtree, Kathryn G. Dewey, Christopher P. Duggan, Caroline H. D. Fall, Abu Syed Golam Faruque, Wafaie W. Fawzi, José Quirino da Silva Filho, Robert H. Gilman, Richard L. Guerrant, Rashidul Haque, Sonja Y. Hess, Eric R. Houpt, Jean H. Humphrey, Najeeha Talat Iqbal, Elizabeth Yakes Jimenez, Jacob John, Sushil Matthew John, Gagandeep Kang, Margaret Kosek, Michael S. Kramer, Alain Labrique, Nanette R. Lee, Aldo Ângelo Moreira Lima, Mustafa Mahfuz, Tjale Cloupas Mahopo, Kenneth Maleta, Dharma S. Manandhar, Karim P. Manji, Reynaldo Martorell, Sarmila Mazumder, Estomih Mduma, Venkata Raghava Mohan, Sophie E. Moore, Ishita Mostafa, Robert Ntozini, Mzwakhe Emanuel Nyathi, Maribel Paredes Olortegui, William A. Petri, Prasanna Samuel Premkumar, Andrew M. Prentice, Harshpal Singh Sachdev, Kamran Sadiq, Rajiv Sarkar, Naomi M. Saville, Saijuddin Shaikh, Bhim P. Shrestha, Sanjaya Kumar Shrestha, Alberto Melo Soares, Bakary Sonko, Aryeh D. Stein, Erling Svensen, Sana Syed, Fayaz Umrani, Honorine D. Ward, Keith P. West, Lee Shu Fune Wu, Seungmi Yang, Pablo Penataro Yori
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. © 2023, The Author(s).
Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States; Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States; Chan Zuckerberg Biohub, San Francisco, CA, United States; Hafen Consulting, West Richland, WA, United States; DVPL Tech, Dubai, United Arab Emirates; Cytel, Waltham, MA, United States; Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, United States; Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Nutrition, University of California, Davis, Davis, CA, United States; Francis I. Proctor Foundation, University of California, San Francisco, CA, United States; Department of Ophthalmology, University of California, San Francisco, CA, United States; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan; JiVitA Project, John Hopkins Bangladesh, Rangpur, Bangladesh; Center for Child, Adolescent, and Maternal Health Research, Department of Medicine and Health Technology, Tampere University, Tampere, Finland; Tampere University Hospital, Tampere, Finland; World Health Organization, Geneva, Switzerland; Center of Data and Knowledge Integration for Health, Fundação Oswaldo Cruz, Salvador, Brazil; UNICEF, New York, NY, United States; HIV/AIDS and Global Health Research Programme, University of Venda, Thohoyandou, South Africa; Indian Institute of Technology, New Delhi, India; Centre for Health Research and Development, Society for Applied Studies, New Delhi, India; Sunder Lal Jain Hospital, Ashok Vihar, New Delhi, India; Centre of Excellence in Women and Child Health, Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; USC Office of Population Studies Foundation, University of San Carlos, Cebu, Philippines; Rollins School of Public Health, Emory University, Atlanta, GA, United States; Leeds Institute for Medical Research, St James’s University Hospital, University of Leeds, Leeds, United Kingdom; Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, United States; Center for Nutrition, Boston Children’s Hospital, Boston, MA, United States; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Federal University of Ceará, Fortaleza, Brazil; University of Virginia, Charlottesville, VA, United States; Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States; Christian Medical College, Vellore, India; Low Cost Effective Care Unit, Christian Medical College, Vellore, India; Translational Health Science and Technology Institute, Faridabad, India; McGill University, Montreal, QC, Canada; McGill University Health Centre, Montreal, QC, Canada; Department of Nutrition, School of Health Sciences, University of Venda, Thohoyandou, South Africa; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi; Mother and Infant Research Activities, Kathmandu, Nepal; Department of Pediatrics and Child Health, Muhimbili University School of Health and Allied Sciences, Dar es Salaam, Tanzania; Haydom Lutheran Hospital, Haydom, Tanzania; Department of Women and Children’s Health, Kings College London, London, United Kingdom; MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Department of Animal Sciences, School of Agriculture, University of Venda, Thohoyandou, South Africa; AB PRISMA, Lima, Peru; Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India; Institute for Global Health, University College London, London, United Kingdom; Health Research and Development Forum, Kathmandu, Nepal; Walter Reed AFRIMS Research Unit, Kathmandu, Nepal; Haukeland University Hospital, Bergen, Norway; Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States
