Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Comments on “Stunting is not a synonym of malnutrition”

To the Editor:

After reading this paper published online on 29th of May 2019, we would like to raise our concern as it will mislead readers when they want to know about stunting. Stunting is a continuation process that does not happen abruptly. It starts with linear growth faltering process, where a child does not grow in length or height in accordance with his/her potential. It may begin very early in life, typically in utero, and generally continues during the first 2 postnatal years [1]. There are many important factors that can cause stunting such as household and family factors, inadequate infant-feeding practices and infection [1, 2]. The study by Scheffler et al. examined stunted children in 6–13.2-year-old age group, without trying to look for the causes of this condition. Stunted children can be caused by other factors such as familial short stature, constitutional delay of growth and development, genetic disorders, endocrine disorders, etc. Doing a study about stunting without identifying all these important factors might mislead the conclusion drawn from the study.

Scheffler et al. stated that the analysis of their study rejected the hypotheses all of which are based on the conventional definition of height stunting as due primarily to nutritional inadequacy [1]: stunted children are not uniformly characterized by depleted fat stores [2]; fat stores of less stunted children are not less depleted and better parental education does not minimize the risk of child undernutrition [3]; stunted children do not exhibit visible clinical signs of PEM. In their study they examined the 6–13.2-year-old children that were stunted. As the stunted growth might begin earlier, they might not find PEM signs and infections no more, moreover if they looked for these signs where actually the stunted children were not caused by stunting. As the children were recovered from stunting, they can have good nutritional status which are described as normal skinfold thickness/normal BMI and also can be found in overweight or obese because of the metabolic syndrome [3, 4]. The study from Rolfe et al. found that subjects who experienced early stunting had accumulated less fat-free mass that predisposed them towards obesity [3]. Study from Vonaesch et al. [4] found that stunting was associated with being overweight after some years with the adjusted OR of 3.21 (95% CI: 1.50; 6.90). So it is not mandatory to find the stunted children (caused by stunting process) have low skinfold thickness.

At the end of their study, Scheffler et al. questioned about the inappropriate use of global growth standards to conclude stunting and stimulated a debate about the inappropriate misapplication of a global growth reference derived from high socioeconomic and mostly westernized populations. Looking back to the history of how the WHO child growth standards was made, we knew it was based on longitudinal observation from five continents where children of well-off populations in developing countries experience similar growth patterns to those of healthy, well-nourished children in developed countries. A critical result of the study was the remarkable similarity in linear growth of the six Multicentre Growth Reference Study Group populations (3 and 70% interindividual and intersite variability, respectively), demonstrating that, when health, environmental, and care needs are met, the potential of growth is universal to at least 5 years of age. This growth standard is a symbol of children’s right to achieve their genetic growth potential [1].

Based on these available data, the conclusion of this paper should be questioned. The scientific evidence is clear and convincing that stunting is the result of poor nutrition, infection, together with socioeconomic influences and it is also clear that stunting is not synonymous with stunted.


  1. 1.

    De Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016;12:12–26.

    Article  Google Scholar 

  2. 2.

    Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr. 2013;9:27–45.

    Article  Google Scholar 

  3. 3.

    Rolfe EL, Franca GVA, Vianna CA, Gigante DP, Miranda JJ, Yudkin JS, et al. Associations of stunting in early childhood with cardiometabolic risk factors in adulthood. PloS ONE. 2018;13:e0192196.

    Article  Google Scholar 

  4. 4.

    Vonaesch P, Tondeur L, Breurec S, Bata P, Nguyen LBL, Frank T, et al. Factors associated with stunting in healthy children aged 5 years and less living in Bangui (RCA). PLoS ONE. 2017;12:e0182363.

    Article  Google Scholar 

Download references

Author information




CT, TP, and DRS wrote the paper. All authors read and approved the final paper.

Corresponding author

Correspondence to Conny Tanjung.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tanjung, C., Prawitasari, T. & Rusli Sjarif, D. Comments on “Stunting is not a synonym of malnutrition”. Eur J Clin Nutr 74, 527–528 (2020).

Download citation

Further reading


Quick links