儿童在中度急性营养不良治疗期间的身体成分变化：来自塞拉利昂一项 4 臂群组随机试验的结果。
Body Composition Changes in Children during Treatment for Moderate Acute Malnutrition: Findings from a 4-Arm Cluster-Randomized Trial in Sierra Leone.
机构信息
Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA.
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
出版信息
J Nutr. 2021 Jul 1;151(7):2043-2050. doi: 10.1093/jn/nxab080.
BACKGROUND
Measures that better describe "healthy" and sustainable recovery during nutritional treatment of children with moderate acute malnutrition (MAM) are needed.
OBJECTIVES
We compared changes to body composition among children receiving 1 of 4 specialized nutritious food (SNFs) during treatment of MAM and by recovery and relapse outcomes.
METHODS
The study was nested within a prospective, cluster-randomized, community-based, cost-effectiveness trial assessing 4 SNFs to treat children aged 6-59 mo with MAM [midupper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema] in Sierra Leone. Biweekly SNF rations (1 of 3 fortified-blended foods or a lipid-based nutrient supplement) were given until children recovered (MUAC ≥12.5 cm), or up to 7 rations (∼12 wk). Deuterium dilution was used to estimate fat-free mass (FFM) and fat mass (FM) at enrollment and after 4 wk of treatment to ensure similar treatment exposure among the participants. Another MUAC measurement was performed among recovered children 4 wk after program exit to determine whether recovery was sustained. ANOVA, paired t tests, and linear regression models were used to determine significant differences in changes from baseline to 4 wk.
RESULTS
Among 312 analyzed participants, mean baseline weight comprised ∼80% FFM; mean weight gained after 4 wk comprised ∼82% FFM. Changes in FM and FFM among 4 SNFs were similar. Children who recovered gained more weight (241%), FFM (179%), and weight-for-height z score (0.44 compared with 0) compared with those who did not recover; sustainers gained 150% more weight. FM gains were positive among recovered children and sustainers, as well as negative among those who did not recover or sustain recovery, but not significantly different.
CONCLUSIONS
Four SNFs had similar effects on body composition in children after 4 wk of treatment for MAM, showing a healthy pattern of weight gain, the majority being FFM. Differential responses to treatment underscore a need for further research to provide targets for healthy, sustainable recovery. This trial was registered at clinicaltrials.gov as NCT03146897.
背景
在中度急性营养不良（MAM）患儿的营养治疗中，需要更好地描述“健康”和可持续恢复的指标。
目的
我们比较了在治疗 MAM 期间和根据恢复和复发结果接受 4 种特殊营养食品（SNF）之一的儿童的身体成分变化。
方法
该研究嵌套在一项前瞻性、集群随机、基于社区、成本效益试验中，评估了 4 种 SNF 治疗年龄在 6-59 个月、患有 MAM 的儿童（上臂中部周长（MUAC）≥11.5cm 且无双下肢水肿），在塞拉利昂。每周两次给予 SNF 配给（3 种强化混合食品之一或脂基营养补充剂），直到儿童恢复（MUAC≥12.5cm），或最多 7 个配给（约 12 周）。在入组时和治疗 4 周后使用氘稀释法估计去脂体重（FFM）和脂肪量（FM），以确保参与者之间有相似的治疗暴露。在项目结束后 4 周，对已恢复的儿童进行另一次 MUAC 测量，以确定恢复是否持续。使用方差分析、配对 t 检验和线性回归模型来确定从基线到 4 周的变化有显著差异。
结果
在 312 名分析参与者中，平均基线体重由约 80%FFM 组成；治疗 4 周后体重增加了约 82%FFM。4 种 SNF 之间 FM 和 FFM 的变化相似。与未恢复的儿童相比，恢复的儿童体重增加（241%）、FFM（179%）和身高体重 Z 评分（0.44 与 0）更高；维持者的体重增加了 150%。恢复和维持恢复的儿童 FM 增加为正，而未恢复或未维持恢复的儿童 FM 增加为负，但无显著差异。
结论
在 MAM 患儿接受 4 周治疗后，4 种 SNF 对身体成分的影响相似，显示出健康的体重增加模式，大部分是 FFM。对治疗的不同反应突出表明需要进一步研究，以提供健康、可持续恢复的目标。本试验在 clinicaltrials.gov 注册为 NCT03146897。
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