在腹泻儿童中，上臂中部周长比基于体重的营养状况测量指标更具优势。
Midupper Arm Circumference Outperforms Weight-Based Measures of Nutritional Status in Children with Diarrhea.
作者信息
Modi Payal, Nasrin Sabiha, Hawes Meagan, Glavis-Bloom Justin, Alam Nur H, Hossain M Iqbal, Levine Adam C
机构信息
The Warren Alpert Medical School, Brown University, Providence, RI;
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; and.
出版信息
J Nutr. 2015 Jul;145(7):1582-7. doi: 10.3945/jn.114.209718. Epub 2015 May 13.
BACKGROUND
Undernutrition contributes to 45% of all deaths in children <5 y of age worldwide, with a large proportion of those deaths caused by diarrhea. However, no validated tools exist for assessing undernutrition in children with diarrhea and possible dehydration.
OBJECTIVE
This study assessed the validity of different measures of undernutrition in children with diarrhea.
METHODS
A prospective cohort study was conducted at an urban hospital in Bangladesh. Children <60 mo of age presenting to the hospital rehydration unit with acute diarrhea were eligible for enrollment. Study staff randomly selected 1196 children for screening, of which 1025 were eligible, 850 were enrolled, and 721 had complete data for analysis. Anthropometric measurements, including weight-for-age z score (WAZ), weight-for-length z score (WLZ), midupper arm circumference (MUAC), and midupper arm circumference z score (MUACZ), were calculated pre- and posthydration in all patients. Measurements were evaluated for their ability to correctly identify undernutrition in children with varying degrees of dehydration.
RESULTS
Of the 721 patients with full data for analysis, the median percent dehydration was 4%. Of the 4 measures evaluated, MUAC and MUACZ demonstrated 92-94% agreement pre- and posthydration compared with 69-76% for WAZ and WLZ. Although each 1% change in hydration status was found to change weight-for-age by 0.0895 z scores and weight-for-length by 0.1304 z scores, MUAC and MUACZ were not significantly affected by dehydration status. Weight-based measures misclassified 12% of children with severe underweight and 14% with severe acute malnutrition (SAM) compared with only 1-2% for MUAC and MUACZ.
CONCLUSIONS
MUAC and MUACZ were the most accurate predictors of undernutrition in children with diarrhea. WAZ and WLZ were significantly affected by dehydration status, leading to the misdiagnosis of many patients on arrival with severe underweight and SAM. This trial was registered at clinicaltrials.gov as NCT02007733.
背景
全球5岁以下儿童死亡中有45%归因于营养不良，其中很大一部分死亡是由腹泻导致的。然而，目前尚无经过验证的工具可用于评估腹泻且可能伴有脱水的儿童的营养不良情况。
目的
本研究评估了不同营养不良测量方法在腹泻儿童中的有效性。
方法
在孟加拉国一家城市医院开展了一项前瞻性队列研究。60月龄以下因急性腹泻到医院补液科就诊的儿童符合入组条件。研究人员随机选取1196名儿童进行筛查，其中1025名符合条件，850名入组，721名有完整数据用于分析。所有患者在补液前后均计算了人体测量指标，包括年龄别体重Z评分（WAZ）、身长别体重Z评分（WLZ）、上臂中部周长（MUAC）和上臂中部周长Z评分（MUACZ）。评估了这些测量指标正确识别不同程度脱水儿童营养不良情况的能力。
结果
在721名有完整分析数据的患者中，脱水的中位数百分比为4%。在评估的4项测量指标中，MUAC和MUACZ在补液前后的一致性为92 - 94%，而WAZ和WLZ为69 - 76%。尽管发现补液状态每变化1%，年龄别体重会变化0.0895个Z评分，身长别体重会变化0.1304个Z评分，但MUAC和MUACZ不受脱水状态的显著影响。基于体重的测量指标将12%的严重体重不足儿童和14%的重度急性营养不良（SAM）儿童误分类，而MUAC和MUACZ仅为1 - 2%。
结论
MUAC和MUACZ是腹泻儿童营养不良最准确的预测指标。WAZ和WLZ受脱水状态的显著影响，导致许多初诊时严重体重不足和SAM的患者被误诊。本试验在clinicaltrials.gov注册，注册号为NCT02007733。
Zotero 插件