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Stunting is not a synonym of malnutrition

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journal contribution
posted on 16.11.2020, 15:28 by C Scheffler, M Hermanussen, Barry Bogin, DS Liana, F Taolin, PMVP Cempaka, M Irawan, LF Ibbibah, NK Mappapa, MKE Payong, AV Homalessy, A Takalapeta, S Apriyanti, MG Manoeroe, FR Dupe, RRK Ratri, SY Touw, PV K, BJ Murtani, R Nunuhitu, R Puspitasari, IK Riandra, AS Liwan, P Amandari, AAI Permatasari, M Julia, J Batubara, A Pulungan
© 2019, The Author(s), under exclusive licence to Springer Nature Limited. Background: WHO documents characterize stunting as, “…impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation.” The equation of stunting with malnutrition is common. This contrasts with historic and modern observations indicating that growth in height is largely independent of the extent and nature of the diet. Subjects: We measured 1716 Indonesian children, aged 6.0–13.2 years, from urban Kupang/West-Timor and rural Soe/West-Timor, urban Ubud/Bali, and rural Marbau/North Sumatra. We clinically assessed signs of malnutrition and skin infections. Results: There was no relevant correlation between nutritional status (indicated by skinfold thickness) and height SDS (hSDS). In total 53% of boys, and 46% girls in rural Soe were stunted, with no meaningful association between mean of triceps and subscapular skinfolds (x̅SF) and height. Skinfold thickness was close to German values. Shortest and tallest children did not differ relevantly in skinfold thickness. 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. In total 35.6% boys and 29.2% girls in urban Ubud were overweight; 21.4% boys and 12.4% girls obese, but with mean hSDS = −0.3, still short. Relevant associations between hSDS and x̅SF and MUAC were only found among the overweight urban children confirming that growth is accelerated in overweight and obese children. There were no visible clinical signs of malnutrition or chronic infection in the stunted children. Conclusion: The present data seriously question the concept of stunting as prima facie evidence of malnutrition and chronic infection.

History

School

  • Sport, Exercise and Health Sciences

Published in

European Journal of Clinical Nutrition

Volume

74

Issue

3

Pages

377 - 386

Publisher

Springer

Version

AM (Accepted Manuscript)

Rights holder

© The authors

Publisher statement

This paper was accepted for publication in the journal European Journal of Clinical Nutrition and the definitive published version is available at https://doi.org/10.1038/s41430-019-0439-4

Acceptance date

05/05/2019

Publication date

2019-05-29

Copyright date

2020

ISSN

0954-3007

eISSN

1476-5640

Language

en

Depositor

Prof Barry Bogin Deposit date: 14 November 2020

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