Have you seen [url=http://www.cmamforum.org/Pool/Resources/Wasting-and-stunting-technical-briefing-2014.pdf]this review paper[/url]?

Thanks Mark. It was indeed a very interesting technical paper and it clearly shows that more efforts need to be poured to understand association between wasting and stunting. I did learn a lot from the paper that you shared. So going back to my "theoretical" question, what can be the possible answer to this?

I am not sure that there is a simple answer since the interpretation of low WHZ is not universal. In (e.g.) warm-climate pastoralists we would expect low WHZ in the healthiest (least stunted) children. In this case it is body shape in the absence of pathology not pathology as is often assumed (i.e. WHZ is, for some children, not measuring "wasting" but reflecting healthy growth). Another issue with the question is that "humanitarian crisis" is not well defined (e.g. Syria and Nepal do share similarities but are very different crises). I agree that lower surface area (as we see in stunted children) has some "nutritional" advantage in terms of energy expenditure to maintain body temperature in cold climate. But may be disadvantageous for the same reason in warmer climates. In any case, the stunted child starts with lower muscle mass and, with a breakdown in public health leading to increased infection (a type of / feature of a humanitarian crisis), these children would be at a disadvantage. The stunted children will likely experience higher mortality than the wasted by WHZ only children. In the light of child-survival programming the non-stunted will usually do better than the stunted children. BTW ... defining wasting with WHZ is, I think, unique to "nutritionism". Other branches of medicine would look to loss of peripheral tissue as a defining characteristic of clinically significant "wasting". This is probably not much help. Others (Mile, André, Carlos) may be better able to answer this question.

Thanks Mark. This is of great help.

No, stunted children more prone to be wasted than normal, becuase they have already in kind of Malnutrition so they aye vulnerable

Dear Frederich, The relation between wasting and stunting is complex and not fully understood. The view you present, namely « We all know that wasting is an indicator of acute malnutrition and stunting is an indicator of chronic malnutrition » is rather simplistic and presumably incorrect. There may be two different situations In some cases, there may be an overall food / energy deficit with a high prevalence of wasting. In these situations, children are likely to have low body fat stores, and there is evidence that this can limit their growth in height. In this case, you would expect most wasted children to be stunted as well. When the quality of diet is poor, but there is no major food/energy deficit, it looks quite plausible that children accumulate an excess of fat instead of growing in height. This at least has been observed in malnourished children receiving zinc poor diets. In that case, you may have the most stunted children having the highest weight-for-height. Of course, you have situations where you have at the same time a problem with diet quality and quantity. Interpretation of the relationship between wasting and stunting is not easy in these cases. We wrote recently a review on this issue that may be of interest to you. See : Briend A, Khara T, Dolan C. Wasting and stunting--similarities and differences: policy and programmatic implications. Food Nutr Bull. 2015 Mar;36(1 Suppl):S15-23. http://nsinf.publisher.ingentaconnect.com/content/nsinf/fnb/2015/00000036/A00101s1/art00003 By the way, MUAC is not an indicator of wasting, but of a high risk of death. Not the same thing. I hope this helps,

Dear Dr. Briend, Thank you for you reply. I read your manuscript and it is really very enlightening. Hopefully the simplistic perception of what is wasting and stunting, what is chronic and acute malnutrition, et cetera be understood by many. : )