Indian Pediatr. 2022 Jul 12:S097475591600441. Online ahead of print.
ABSTRACT
BACKGROUND: Wasting and stunting commonly coexist, supposedly due to biological and social mechanisms. In under-five children, low-ponderosity is defined as <-2SD of WHO standards for either weight for height (wasted) or body mass index-for-age (thin) metrics. Unlike body mass index-for-age, weight for height ignores physiological changes in ponderosity with age, resulting in overestimation of wasting in comparison to thin-ness in under-5 populations with high stunting prevalence. This suggests a plausible statistical explanation for the wasting-stunting association.
AIM: To test the null hypothesis that wasting-stunting (WaSt) and thinness-stunting (ThSt) associations are similar.
METHODS: Demographic Health Survey datasets (2010-2020) from South and South-East Asia (7 countries) and Sub-Saharan Africa (13 countries) were evaluated. WaSt and ThSt associations were estimated as odds ratio (OR) for individual datasets, which was pooled (random-effects meta-analysis). Stratified analyses were done for sex, age and region.
RESULTS: Young infants (0-6 months) comprised 8-14% of under-five children, with equal representation of boys and girls. Participants, especially Asians, were mostly shorter with lower ponderosity than WHO stand-ards. WaSt prevalence was higher than ThSt in the 6-59 months age group, but lower in young infants. Pooled WaSt estimates were not significant: Asia (OR 0.95; 95% CI 0.75-1.14), Africa (1.17; 0.95-1.40), and combined (1.09; 0.93-1.24). In contrast, pooled ThSt associations were significantly negative: Asia (0.63; 0.50-0.76), Af-rica (0.82; 0.68-0.96), and combined (0.75; 0.65-0.85). In girls, these associations were attenuated for WaSt (0.96; 0.8-1.1), but enhanced for ThSt (0.6; 0.5-0.7).
CONCLUSION: WaSt and ThSt associations are dissimilar. This suggests a primary statistical explanation for the reported wasting-stunting association, originating from ignoring physiological changes with age.
PMID:35822490
