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Background: Nutrition programs frequently approach wasting and stunting as 2 separate conditions with distinct causes and effects. Although several cross-sectional studies have identified an association between the 2 conditions, longitudinal studies are useful to quantify the risk of acute malnutrition based on the trajectory of linear growth.Objective: We analyzed data from a longitudinal study to explore associations between linear growth and relapse to acute malnutrition in high-risk children during the year after recovery from moderate acute malnutrition (MAM).Methods: This was a secondary data analysis from a cluster randomized trial involving 1487 Malawian children 6-62 mo old treated for MAM and enrolled upon recovery. Children were followed for 1 y, during which data were collected on anthropometric progress, symptoms of illness, and household food security. Multivariate fixed-effects logistic regression was used to identify associations between linear growth and relapse to acute malnutrition.Results: Children who have recovered from MAM proved to be a high-risk population, with nearly half experiencing a decrease in height-for-age z score (HAZ) for 12 mo. Children whose HAZ was declining were more likely to relapse to MAM or SAM than were those whose linear growth rate maintained or increased their HAZ (P < 0.001). Mean changes of +0.15, -0.03, -0.17, and -0.53 in HAZ were observed for those who sustained recovery, relapsed to MAM once, relapsed to MAM multiple times, and developed SAM, respectively.Conclusion: Our results add to the body of evidence suggesting that acute wasting is a harbinger of subsequent stunting. Children who experience poor linear growth after MAM are more likely to experience relapse. Given this bidirectional relation between wasting and stunting, supplementary feeding programs should consider both when designing protocols, aiming to optimize linear growth and achieve acute weight gain, as a means of reducing relapse. This trial was registered at clinicaltrials.gov as NCT02351687. [ABSTRACT FROM AUTHOR]

This paper compares a qualitative and a quantitative (Rasch) method of item assessment for developing the content of a food insecurity scale for Bangladesh. Data are derived from the Bangladesh Food Insecurity Measurement and Validation Study, in which researchers collected 2 rounds of ethnographic information and 3 rounds of conventional household survey data between 2001 and 2003. The qualitative method of scale development relied on content experts and respondents themselves to evaluate household food insecurity items generated through ethnographic research. The quantitative method applied the Rasch model to assess the fit of the same items using representative survey data. The Rasch model was then used to test for differential item functioning (DIF) across diverse demographic and geographic subgroups. The qualitative assessment flagged and discarded 10 items, leaving 13. The Rasch assessment of infit and outfit flagged 3 items, and the Rasch DIF test discarded another 10 items, leaving a total of 10 items in the Rasch-derived scale. The 2 scales contained 8 of the same items. The qualitatively and quantitatively derived scales were highly correlated (r = 0.96, P < 0.01), and the 2 methods located 90% of households in the same food insecurity tercile. This convergence lends added confidence to the use of either scale for identifying food-insecure households in different regions of Bangladesh. Multiple methods should continue to be applied in a systematic and transparent way to lend additional credence to the results when they converge and to pinpoint directions for further clarification where they do not. [ABSTRACT FROM AUTHOR]