Clinical significance of the heterogeneous anthropometry-based case definitions of severe acute malnutrition in children : results of the multi-centric OptiDiag study and policy implications

Korte inhoud:Introduction: While both WHZ<-3SD and MUAC<115mm are recommended by WHO as independent criteria to identify children suffering from Severe Acute Malnutrition (SAM) and to refer them to treatment, using MUAC as a sole indicator to identify SAM children is becoming increasingly popular. Indeed, some long-standing, yet controversial, expert statements articulate that SAM children with a low MUAC are most at risk, and that adding WHZ to screening or treatment protocols would present no benefit for detecting mortality risk. Objective: In order to elucidate this, the OptiDiag study aimed to describe the nutritional status and morbi-mortality risks associated with the different case definitions of SAM. Methods: We conducted a multi-centric cohort study in uncomplicated SAM children with low MUAC alone, low WHZ alone, and the combination of low MUAC and low WHZ, in Bangladesh, Burkina Faso, and Liberia. Alongside routine anthropometric measurements, we collected a range of indicators of clinical and nutritional status, among which some novel biomarkers of body metabolism and mortality risk, such as serum leptin. Indeed, hypoleptinemia has recently emerged as a powerful risk factor for acute mortality in children with SAM. Results: The 3 groups included patients with low MUAC only (n =161), low WHZ only (n =138), and both low MUAC & low WHZ (n =152). At diagnosis, leptin levels were lower in patients with reduced WHZ (308.8±28.8 pg/mL, p=0.019) and with both low MUAC & low WHZ (244.9±17.4 pg/mL, p<0.0001) than in children with low MUAC alone (414.0±27.7 pg/mL). These observations were consistent with a range of other clinically significant indicators, like urine ketonuria, visible signs of severe wasting, and maternal report. Presented at: The 4th Federation of African Nutrition Societies (FANUS) Kigali Conference; August 26th - 29th, 2019, Lemigo Hotel Kigali, Rwanda; “Nutrition in Action for Sustainable Development in Africa”; theme: Malnutrition; forms, trends, causalities, innovations and cost. Presenting Author: Trenton Dailey-Chwalibóg, M.P.H., Ph.D. Candidate, Trenton@Dailey-Chwalibog.com.

Jaar van publicatie:2019

Toegankelijkheid:Open