Kamugisha Jolly G K, Lanyero Betty, Nabukeera-Barungi Nicolette, Ritz Christian, Mølgaard Christian, Michaelsen Kim F, Briend André, Mupere Ezekiel, Friis Henrik, Grenov Benedikte
Mwanamugimu Nutrition Unit, Department of Pediatrics, Mulago National Referral Hospital, Kampala, Uganda.
World Health Organization, Ethiopia Country Office, UNECA Compound, Addis Ababa, Ethiopia.
Curr Dev Nutr. 2021 Sep 25;5(10):nzab118. doi: 10.1093/cdn/nzab118. eCollection 2021 Oct.
Linear catch-up growth after treatment of severe acute malnutrition (SAM) is low, and little is known about the association between ponderal and subsequent linear growth.
The study assessed the association of weight-for-height -score (WHZ) gain with subsequent linear growth during SAM treatment and examined its modifiers.
This was a prospective study, nested in a trial (ISRCTN16454889), among 6-59-mo-old children treated for SAM in Uganda. Weight, total length (TL), and knee-heel length (KHL) were measured at admission, weekly during inpatient therapeutic care (ITC), at discharge, and fortnightly during outpatient therapeutic care (OTC) for 8 wk. Linear regression was used to assess the association between WHZ gain during ITC and linear growth during OTC.
Of 400 children, 327 were discharged to OTC and 290 were followed up for 8 wk. Mean WHZ gains were 0.45 in ITC and 1.24 in OTC, whereas mean height-for-age -score (HAZ) declined by 0.41 during ITC and increased by 0.14 during OTC. WHZ gain during ITC was positively associated with HAZ, TL, and KHL gains during OTC [regression coefficients (β) (95% CI): 0.12 (0.09, 0.15) -score; 3.1 (2.4, 3.8) mm and 0.5 (0.1, 0.7) mm, respectively]. The regression coefficients were highest for the middle tertile of WHZ gain with respect to HAZ and TL. Admission diarrhea and low plasma citrulline reduced the association between WHZ gain during ITC and HAZ and TL gain during OTC ( < 0.001). In contrast, pneumonia ( = 0.051) and elevated plasma C-reactive protein ( < 0.001) increased the association with TL gain, but reduced the association with KHL gain ( < 0.001).
Among children admitted with SAM, considerable WHZ gain during ITC was followed by very modest linear catch-up growth during OTC, with no indication of a WHZ gain threshold, above which linear growth was higher. To optimize linear growth in these children, early treatment of infections and conditions affecting the gut may be necessary.
重度急性营养不良（SAM）治疗后的线性追赶生长水平较低，关于体格生长与后续线性生长之间的关联知之甚少。
本研究评估了身高别体重评分（WHZ）增加与SAM治疗期间后续线性生长之间的关联，并研究了其影响因素。
这是一项前瞻性研究，嵌套于一项试验（ISRCTN16454889）中，研究对象为乌干达6至59个月大接受SAM治疗的儿童。在入院时、住院治疗护理（ITC）期间每周、出院时以及门诊治疗护理（OTC）的8周内每两周测量体重、身长（TL）和膝跟长（KHL）。采用线性回归评估ITC期间WHZ增加与OTC期间线性生长之间的关联。
400名儿童中，327名出院接受OTC治疗，290名接受了8周的随访。ITC期间WHZ的平均增加量为0.45，OTC期间为1.24，而年龄别身高评分（HAZ）在ITC期间下降了0.41，在OTC期间增加了0.14。ITC期间WHZ的增加与OTC期间HAZ、TL和KHL的增加呈正相关[回归系数（β）（95%CI）：分别为0.12（0.09，0.15）评分；3.1（2.4，3.8）mm和0.5（0.1，0.7）mm]。就HAZ和TL而言，WHZ增加处于中间三分位数时回归系数最高。入院时腹泻和血浆瓜氨酸水平低降低了ITC期间WHZ增加与OTC期间HAZ和TL增加之间的关联（P<0.001）。相比之下，肺炎（P=0.051）和血浆C反应蛋白升高（P<0.001）增加了与TL增加的关联，但降低了与KHL增加的关联（P<0.001）。
在因SAM入院的儿童中，ITC期间WHZ显著增加之后，OTC期间线性追赶生长非常有限，且未显示出WHZ增加存在阈值，超过该阈值线性生长会更高。为优化这些儿童的线性生长，可能有必要早期治疗感染和影响肠道的疾病。
