Department of Expertise and Advocacy, Action Contre la Faim, Paris, France;
Université Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 75005, Paris, France.
Pediatrics. 2021 Jun;147(6). doi: 10.1542/peds.2020-027003. Epub 2021 May 21.
Use of mid-upper arm circumference (MUAC) as a single screening tool for severe acute malnutrition (SAM) assumes that children with a low weight-for-height score (WHZ) and normal MUAC have lower risks of morbidity and mortality. However, the pathophysiology and functional severity associated with different anthropometric phenotypes of SAM have never been well characterized. We compared clinical characteristics, biochemical features, and health and nutrition histories of nonedematous children with SAM who had (1) low WHZ only, (2) both low WHZ and low MUAC, or (3) low MUAC only.
In Bangladesh, Burkina Faso, and Liberia, we conducted a multicentric cohort study in uncomplicated, nonedematous children with SAM and low MUAC only ( = 161), low WHZ only ( = 138), or a combination of low MUAC and low WHZ ( = 152). Alongside routine anthropometric measurements, we collected a wide range of critical indicators of clinical and nutritional status and viability; these included serum leptin, an adipocytokine negatively associated with mortality risk in SAM.
Median leptin levels at diagnosis were lower in children with low WHZ only (215.8 pg/mL; < .001) and in those with combined WHZ and MUAC deficits (180.1 pg/mL; < .001) than in children with low MUAC only (331.50 pg/mL). The same pattern emerged on a wide range of clinical indicators, including signs of severe wasting, dehydration, serum ferritin levels, and caretaker-reported health deterioration, and was replicated across study sites.
Illustrative of the likely heterogeneous functional severity of the different anthropometric phenotypes of SAM, our results confirm the need to retain low WHZ as an independent diagnostic criterion.
使用中上臂围（MUAC）作为严重急性营养不良（SAM）的单一筛查工具，假设体重与身高比（WHZ）低且 MUAC 正常的儿童罹患发病率和死亡率较低。然而，SAM 的不同人体测量表型相关的病理生理学和功能严重程度从未得到很好的描述。我们比较了非水肿性 SAM 患儿的临床特征、生化特征、健康和营养史，这些患儿具有（1）仅低 WHZ，（2）低 WHZ 和低 MUAC，或（3）仅低 MUAC。
在孟加拉国、布基纳法索和利比里亚，我们对非水肿性 SAM 且仅 MUAC 低的儿童（=161）、仅 WHZ 低的儿童（=138）或 MUAC 和 WHZ 均低的儿童（=152）进行了一项多中心队列研究。除了常规的人体测量测量外，我们还收集了广泛的临床和营养状况以及生存能力的关键指标；这些指标包括血清瘦素，瘦素是一种与 SAM 死亡率呈负相关的脂肪细胞因子。
仅 WHZ 低的儿童（215.8 pg/mL；<0.001）和 WHZ 和 MUAC 均不足的儿童（180.1 pg/mL；<0.001）的诊断时中位瘦素水平低于仅 MUAC 低的儿童（331.50 pg/mL）。这一模式在广泛的临床指标中都出现了，包括严重消瘦、脱水、血清铁蛋白水平和照顾者报告的健康恶化的迹象，并且在各个研究地点都得到了复制。
这些结果说明了 SAM 的不同人体测量表型的可能不同的功能严重程度，证实了需要保留低 WHZ 作为独立的诊断标准。
