Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark;
Médecins Sans Frontières, Denmark, Copenhagen, Denmark.
Pediatrics. 2018 Sep;142(3). doi: 10.1542/peds.2018-0679.
In moderate acute malnutrition programs, it is common practice to not measure mid-upper arm circumference (MUAC) of children whose length is <67 cm. This is based on expert opinion that supplementation of shorter children with low MUAC and weight-for-height score ≥-2 may increase risk of excessive fat accumulation. Our aim was to assess if shorter children gain more fat than taller children when treated for moderate acute malnutrition diagnosed by low MUAC alone.
In this observational study, we included children aged 6 to 23 months with a MUAC between 115 and 125 mm and a weight-for-height score ≥-2. On the basis of length at admission, children were categorized as short if <67 cm and long if ≥67 cm. Linear mixed-effects models were used to assess body composition on the basis of deuterium dilution and skinfold thickness.
After 12 weeks of supplementation, there was no difference in change in fat mass index (-0.038 kg/m, 95% confidence interval [CI]: -0.257 to 0.181, = .74) or fat-free mass index (0.061 kg/m, 95% CI: -0.150 to 0.271, = .57) in short versus long. In absolute terms, the short children gained both less fat-free mass (-230 g, 95% CI: -355 to -106, < .001) and fat mass (-97 g, 95% CI: -205 to 10, = .076). There was no difference in changes in absolute subscapular and triceps skinfold thickness and scores ( > .5).
Short children with low MUAC do not gain excessive fat during supplementation. With these data, we support a recommendation for policy change to include all children ≥6 months with low MUAC in supplementary feeding programs, regardless of length. The use of length as a criterion for measuring MUAC to determine treatment eligibility should be discontinued in policy and practice.
在中度急性营养不良项目中，对于长度小于 67 厘米的儿童，通常不测量中上臂围（MUAC）。这是基于专家意见，即对于 MUAC 和体重身高得分低且小于-2 的较短儿童进行补充，可能会增加过度脂肪积累的风险。我们的目的是评估单独使用低 MUAC 诊断为中度急性营养不良的较矮儿童在接受治疗时是否比较高儿童获得更多的脂肪。
在这项观察性研究中，我们纳入了年龄在 6 至 23 个月之间、MUAC 在 115 至 125 毫米之间且体重身高得分大于等于-2 的儿童。根据入院时的长度，长度小于 67 厘米的儿童归为短，长度大于等于 67 厘米的儿童归为长。使用线性混合效应模型基于氘稀释和皮褶厚度评估身体成分。
在补充 12 周后，短与长儿童的脂肪量指数变化（-0.038kg/m，95%置信区间[CI]：-0.257 至 0.181，=.74）或去脂体重指数变化（0.061kg/m，95%CI：-0.150 至 0.271，=.57）均无差异。从绝对值来看，短儿童的去脂体重（-230g，95%CI：-355 至-106，<.001）和脂肪量（-97g，95%CI：-205 至 10，=.076）均减少。肩胛下和肱三头肌皮褶厚度和 评分的变化无差异（>.5）。
低 MUAC 的短儿童在补充期间不会获得过多的脂肪。有了这些数据，我们支持政策改变的建议，即无论长度如何，将所有 MUAC 低的 6 个月以上儿童纳入补充喂养计划。在政策和实践中，应停止使用长度作为 MUAC 的测量标准来确定治疗资格。
