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Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6−23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.

背景

目前，儿童消瘦管理指南主要侧重于提供治疗性食品和治疗医疗并发症。然而，许多消瘦儿童生活在粮食有保障的家庭中，多项研究表明，消瘦的病因很复杂，包括社会、营养和生物学原因。我们评估了家庭粮食无保障、饮食多样性以及特定食物组的消费对出院后消瘦恢复时间的影响。

方法

我们对儿童急性疾病网络（CHAIN）队列进行了二次分析，这是一项在六个低收入和中低收入国家进行的多中心前瞻性研究。我们纳入了在出院时患有消瘦（中上臂围[MUAC]≤12.5cm）或夸希奥克营养不良（双下肢水肿）的 6-23 个月龄儿童。主要结局是营养恢复时间，定义为 MUAC＞12.5cm 且无水肿。我们使用 Cox 比例风险模型，根据年龄、性别、研究地点、HIV 状况、住院时间、入组 MUAC、转诊至营养计划、照顾者教育、照顾者抑郁、入组季节、居住地点和家庭财富状况进行调整，评估了住院前报告的粮食无保障、饮食多样性和特定食物组对出院后 6 个月内消瘦恢复时间的影响。

结果

在纳入的 1286 名儿童中，大多数参与者（806 名，63%）来自粮食无保障家庭，其中 170 名（13%）为严重粮食无保障，664 名（52%）参与者饮食多样性不足。恢复中位数时间为 96 天（18/100 儿童-月（95%CI：17.0，19.0））。中度（aHR 1.17[0.96，1.43]）和严重粮食无保障（aHR 1.14[0.88，1.48]）以及饮食多样性不足（aHR 1.07[0.91，1.25]）与恢复时间无显著相关性。与未食用豆类和坚果的儿童相比，诊断前食用豆类和坚果的儿童恢复速度更快（调整后的危险比（aHR）：1.21[1.01，1.44]）。食用奶制品（aHR 1.13[0.96，1.34]，p=0.14）和肉类（aHR 1.11[0.93，1.33]，p=0.23）与恢复时间无统计学显著相关性。诊断前食用水果和蔬菜（aHR 0.78[0.65，0.94]）和母乳喂养（aHR 0.84[0.71，0.99]）与恢复时间延长有关。