School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
Department of Pediatrics, Washington University, St. Louis, MO.
J Pediatr Gastroenterol Nutr. 2019 May;68(5):734-737. doi: 10.1097/MPG.0000000000002241.
Malnutrition in children is most often attributed to inadequate nutrient intake. Utilizing data from 2 prospective, randomized controlled trials of complimentary feeding with supplemental legumes (n = 693, ages 6-24 months) in 2 Malawian villages, Masenjere, and Limera, we document a high rate 70/693 (10.1%) of acute malnutrition (AM). Risks for AM in this setting, as determined by Cox regression analysis, include study village (hazard ratio [HR] 3.0), prior malnutrition (HR 4.12), stunting (HR 2.87), and a marker of food insecurity (HR 1.89). Comparison of Masenjere to Limera demonstrate adequate and similar nutritional intake yet an increased rate of AM in Masenjere, 56 of 400 (14.0%) versus 14 of 293 (4.8%), and stunting, 140 of 400 (35%) versus 80 of 293 (27%), environmental enteric dysfunction 246 of 400 (71%) versus 181/293 (67%), and infectious symptoms (cough and diarrhea). Masenjere did have cleaner water and less food insecurity 200 of 399 (50.5%) versus 204 of 293 (69.6%). These findings suggest adequate complementary nutrient intake does not protect young children against AM.
儿童营养不良通常归因于营养摄入不足。利用在马拉维的两个村庄 Masenjere 和 Limera 进行的补充豆类补充喂养的 2 项前瞻性、随机对照试验的数据（n=693，年龄 6-24 个月），我们记录了高比例的急性营养不良（AM），70/693（10.1%）。Cox 回归分析确定了这种情况下 AM 的风险，包括研究村庄（危险比 [HR]3.0）、先前的营养不良（HR4.12）、发育迟缓（HR2.87）和食物不安全的标志物（HR1.89）。将 Masenjere 与 Limera 进行比较，表明 Masenjere 有足够且相似的营养摄入，但急性营养不良的发生率更高，56/400（14.0%）与 14/293（4.8%）相比，发育迟缓率更高，140/400（35%）与 80/293（27%）相比，环境肠功能障碍发生率更高，246/400（71%）与 181/293（67%）相比，传染性症状（咳嗽和腹泻）也更多。Masenjere 的水质更清洁，食物不安全程度更低，200/399（50.5%）与 204/293（69.6%）相比。这些发现表明，充足的补充营养摄入并不能保护幼儿免受 AM 的影响。
