Médecins Sans Frontières, Medical Department, Operational Research, Brussels, Belgium.
Trans R Soc Trop Med Hyg. 2013 May;107(5):319-23. doi: 10.1093/trstmh/trt018. Epub 2013 Mar 6.
Mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) identify different populations of children with severe acute malnutrition (SAM) with only some degree of overlap. In an urban slum in Bangladesh, we conducted a prospective cohort study on children assessed as being severely malnourished by WHZ (<-3) but not by MUAC (>115 mm), to: 1. Assess their nutritional outcomes, and 2. Report on morbidity and mortality.
Children underwent 2-weekly prospective follow-up home visits for 3 months and their anthropometric evolution, morbidity and mortality were monitored.
Of 158 children, 21 did not complete follow-up (six were lost to follow-up and 15 changed residence). Of the remaining 137 children, nine (7%) required admission to the nutrition programme because of: MUAC dropping to <115 mm (5/9 children), weight loss ≥ 10% (1/9 children) and severe medical complications (3/9 children, of whom one died). Of the remaining 128 children who completed follow-up, 91 (66%) improved in nutritional status while 37 (27%) maintained a WHZ of <-3. Cough was less frequent among those whose nutritional status improved.
It seems acceptable to rely on MUAC as a single assessment tool for case finding and for admission of children with SAM to nutritional programmes.
上臂中部周长（MUAC）和体重与身高 Z 评分（WHZ）可识别出严重急性营养不良（SAM）患儿的不同人群，仅有一定程度的重叠。在孟加拉国的一个城市贫民窟，我们对通过 WHZ（<-3）评估为严重营养不良但 MUAC（>115mm）不营养不良的儿童进行了前瞻性队列研究，以：1. 评估他们的营养结局，和 2. 报告发病率和死亡率。
儿童接受了为期 3 个月的每周 2 次前瞻性家庭随访，监测他们的人体测量学演变、发病率和死亡率。
在 158 名儿童中，有 21 名未完成随访（6 名失访，15 名搬家）。在其余的 137 名儿童中，有 9 名（7%）因 MUAC 降至<115mm（5/9 名儿童）、体重减轻≥10%（1/9 名儿童）和严重的医疗并发症（3/9 名儿童，其中 1 名死亡）而需要入院营养治疗。在完成随访的其余 128 名儿童中，91 名（66%）营养状况改善，37 名（27%）WHZ 持续<-3。改善营养状况的儿童咳嗽较少。
似乎可以接受将 MUAC 作为发现病例和将 SAM 患儿纳入营养方案的单一评估工具。
