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Stunting is not always a sign of malnutrition, says study

08 Apr 2020
The epidemic has been escalated further due to malnutrition, lack of clean water and a conflict that has destroyed infrastructure – hampering access to medical supplies.

Stunting does not necessarily equate to malnutrition or chronic infection in children, according to a study in Indonesia.

The World Health Organization defines stunting as “impaired growth and development that children experience from poor nutrition, repeated infection and inadequate psychosocial stimulation.”

While this definition gives the impression that stunting is prima facie evidence of malnutrition, the authors argue that such belief contradicts “historic and modern observation indicating that growth in height is largely independent of the extent and nature of the diet.”

A total of 1,716 Indonesian children (aged, 6.0–13.2 years) were included in the analysis. Participants came from Kupang/West-Timor and rural Soe/West-Timor, urban Ubud/Bali, and rural Marbau/North Sumatra. Signs of malnutrition and skin infections were clinically assessed.

Nutritional status, as indicated by skinfold thickness, was not significantly associated with height standard deviation scores (hSDS).

Fifty-three percent of boys and 46 percent of girls in rural Soe were stunted, with no meaningful association between mean of triceps and subscapular skinfolds (x̅SF) and height. Skinfold thickness was comparable to that of Germans. In addition, skinfold thickness did not significantly differ between shortest and tallest children.

“The same applied for the association between hSDS and mid-upper-arm circumference (MUAC) using linear mixed effects models with both fixed and random effects,” the authors said.

In urban Ubud, 35.6 percent and 21.4 percent of boys were overweight and obese, respectively. The corresponding proportion among girls were 29.2 percent and 12.4 percent. Their mean hSDS was –0.3, which was still deemed short.

Significantly associations between hSDS and x̅SF and MUAC only existed among overweight urban children. This confirmed that overweight and obese children have faster growth. Of note, no visible clinical signs of malnutrition or chronic infection were found in stunted children.

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