In third-world nations, malnutrition is a serious issue and can be categorized in multiple ways. WHO categorizes malnutrition into several types, such as undernutrition (low weight to height ratio), stunning (inappropriate height to age ratio), underweight (low weight to age), micronutrient deficient (deficiency of vitamins and minerals), and overweight (high weight to age, along with obesity and diet-related non-communicable disorders). In 2020, numbers from regions like Africa and Asia were highly concerning as approximately 45.4 million children were wasted, 38.9 million were overweight, and 149.2 million children were stunned. Weight to height Z score is the easiest way to evaluate one’s nutritional status and growth. However, the WHZ score cannot differentiate between fat-free mass and body fat mass, but this distinction is necessary as fat plays a very important role in energy metabolism and brain development.

In this validation study, data from six countries (Cambodia, China, Magnolia, Papua New Guinea, Timor- Leste, Vanuatu) was analyzed for East Asia-Pacific Early Child Development Scale (EAP-ECDS). Bodyweight, mid-upper arm circumference, and triceps skinfold thickness were measured and recorded. 6815 children were included in the study with an average age of 4.02 years and 50.4% of female children in the count. During the study, it was found that children with wasting and low body fat are 1.47 times more likely to have poor development followed by children with low fat but normal weight (1.23 times) in standard comparison to normal weighed and normal fat %age containing children. Similar results were visualizedin the brain’s ability to learn the language, cognitive ability, social skills, and emotional quotient, but no such association with motor development was found. Based on triceps skinfold criteria, compared to the standard values children with wasting and low body fat and children with normal weight but low-fat hag 1.61- and 1.26-times greater likelihood of poor development. 

Petermann et al., JAMA Netw Open. 2022 doi:10.1001/jamanetworkopen.2021. 42458