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Eur J Clin Nutr. 2019 May 29. doi: 10.1038/s41430-019-0439-4. [Epub ahead of print]

Stunting is not a synonym of malnutrition.

Author information

University of Potsdam, Human Biology, 14469, Potsdam, Germany.
Aschauhof, 24340, Altenhof, Germany.
Health and Wellbeing Global Challenge, School of Sport, Exercise & Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK.
Medical Faculty Nusa Cendana University, Kupang-East Nusa Tenggara, Kupang, Indonesia.
East Nusa Tenggara Indonesian Society of Pediatrician, Kupang-East Nusa Tenggara, Kupang, Indonesia.
School of Medicine, University of Sumatera Utara, Medan, Sumatera Utara, Indonesia.
Child Health Department Udayana University Sanglah Hospital, Bali, Indonesia.
Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Department of Child Health, Medical School, University of Indonesia, Jakarta, 10430, Indonesia.
Indonesian Pediatric Society, Malang, Indonesia.
Department of Child Health University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, 10430, Indonesia.



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.


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.


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.


The present data seriously question the concept of stunting as prima facie evidence of malnutrition and chronic infection.


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