ActionAgainst Hunger UK, London, United Kingdom.
School of Human Sciences, University of Western Australia, Perth, Australia.
PLoS One. 2024 Oct 25;19(10):e0312433. doi: 10.1371/journal.pone.0312433. eCollection 2024.
Globally and in Timor-Leste, wasting and stunting remain major public health problems among 'under five years children, but the interrelationship between the two has been poorly investigated. A better understanding of this interrelationship is a prerequisite to improving wasting and stunting programming. In our study, we assessed the influence of age on the prevalence of wasting and stunting, the overlap between the two conditions, and the effect of wasting parameters on linear growth catch-up using the data of 401 children recruited at 0 to 54 months of age [median (IQR) of 17 (7-32) months] with repeated anthropometric assessments [median (IQR) follow-up time was 25 (16-39) months]. At recruitment, prevalences of stunting, wasting and concurrence of the two conditions were 54.6%, 9.5% and 4.6%, respectively. These prevalences were already high and above the thresholds for public health importance among children below months of age and remained high throughouttheir childhood. Over the follow-up period, the change (95%CI) in Height-for-Age Z-score (HAZ) was -0.01 (-0.13; 0.11) (p = 0.850), and that of the Height-for-Age Difference (HAD) was -3.74 (-4.28; -3.21) cm (p<0.001). Stunting reversal was observed in 25.6% of those stunted at recruitment, while a positive change in HAD was observed in only 19.6% of assessed children. Path analysis by structural equation modelling showed no significant direct effect of WHZ at recruitment on the likelihood of positive change in HAD, with its influence being fully mediated by its change over the follow-up period. This change had an inverse relationship with the occurrence of a positive change in HAD. On the contrary, Mid-Upper Arm Circumference at recruitment had a significant positive direct effect on the likelihood of a positive HAD change. These results show that interventions to combat wasting and stunting need to be integrated.
在全球和东帝汶，消瘦和发育迟缓仍然是五岁以下儿童的主要公共卫生问题，但两者之间的相互关系尚未得到充分研究。更好地了解这种相互关系是改善消瘦和发育迟缓规划的前提。在我们的研究中，我们评估了年龄对消瘦和发育迟缓患病率的影响、这两种情况的重叠程度以及消瘦参数对线性生长追赶的影响，研究数据来自 401 名 0 至 54 个月大的儿童（中位数（IQR）为 17（7-32）个月），进行了多次人体测量评估（中位数（IQR）随访时间为 25（16-39）个月）。在招募时，发育迟缓、消瘦和两者同时存在的患病率分别为 54.6%、9.5%和 4.6%。这些患病率已经很高，超过了 0-5 个月以下儿童消瘦和发育迟缓公共卫生重要性的阈值，并在整个儿童期仍然很高。在随访期间，身高年龄 Z 评分（HAZ）的变化（95%CI）为-0.01（-0.13；0.11）（p=0.850），身高年龄差（HAD）的变化为-3.74（-4.28；-3.21）cm（p<0.001）。在招募时患有发育迟缓的儿童中，有 25.6%的儿童出现发育迟缓逆转，而在接受评估的儿童中，只有 19.6%的儿童 HAD 出现正变化。结构方程模型的路径分析显示，招募时 WHZ 对 HAD 正变化的可能性没有显著的直接影响，其影响完全由随访期间的变化介导。这种变化与 HAD 发生正变化呈负相关。相反，招募时中上臂围有显著的正直接效应，对 HAD 正变化的可能性有正向影响。这些结果表明，对抗消瘦和发育迟缓的干预措施需要整合。
