Child malnutrition is usually characterized as contributing to stunting (length for age z scores) or wasting (weight for length z scores), and nutritional interventions have routinely been focused on each form of growth impairment as a separate problem.  Even though wasting may result from food shortages and illness, and stunting is usually attributed to poverty and food insecurity, they are likely linked and thus occurring concurrently.  Prior work in this area does not capture the potential temporal nature of linear and ponderal growth relationships.  Cliffer and colleagues conducted a study to explore this potential relationship and report their results in the August 2022 issue of The Journal of Nutrition.

Subjects in their study were children in Burkina Faso (n = 5039), for whom monthly anthropometric measurements were taken between the ages of 6 and 28 months.  The authors used multilevel mixed-effects models to determine the associations (concurrent and lagged) between linear and ponderal growth velocity.  The models included factors to control for seasonality, morbidity, and time trends.

Children with faster ponderal growth exhibited faster concurrent or subsequent linear growth patterns, and faster linear growth was followed by slower weight gains.  This pattern was especially apparent in children from 9-14 months of age.  Peaks in morbidity were associated with slowing of ponderal growth, followed by slower linear growth occurring about a month later.  These results led the authors to conclude that the same growth limiting conditions likely affect both length and weight velocity, that slow weight gain limits future linear growth, and that if linear growth spurts are not accompanied by sufficient increases in intakes, then weight gains will be slowed.

In an editorial, Hoffman and Posluszny, point out that wasting and stunting have long been treated as distinct forms of malnutrition, and that few programs have been designed to either treat or prevent both at the same time, and that doing so may limit the efficacy of those treatments.  They consider the longitudinal study by Cliffer and colleagues to be an excellent study to evaluate the relationships between weight and linear growth.  They suggest that malnutrition and treatment programs must address the underlying causes of wasting and stunting, and mutisectorial approaches with safety nets for social protection that are integrated with agricultural and food systems approaches will best address the environmental factors contributing to these serious public health concerns.


Ilana R Cliffer, Nandita Perumal, William A Masters, Elena N Naumova, Laetitia Nikiema Ouedraogo, Franck Garanet, Beatrice L Rogers, Linear Growth Spurts are Preceded by Higher Weight Gain Velocity and Followed by Weight Slowdowns Among Rural Children in Burkina Faso: A Longitudinal Study, The Journal of Nutrition, Volume 152, Issue 8, August 2022, Pages 1963–1973,

Daniel J Hoffman, Hannah R Posluszny, Navigating Linear and Ponderal Growth in Undernourished Children, The Journal of Nutrition, Volume 152, Issue 8, August 2022, Pages 1810–1811,

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