Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK.
Emergency Nutrition Network (ENN), Oxford, UK.
Public Health Nutr. 2023 Aug;26(8):1658-1670. doi: 10.1017/S1368980023000411. Epub 2023 Mar 6.
To explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition and describe associations with survival and non-communicable disease (NCD) risk 7 years post-treatment.
Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score and height-for-age z-score (HAZ). Three categorisation methods included no categorisation, quintiles and latent class analysis (LCA). Associations with mortality risk and seven NCD indicators were analysed.
Secondary data from Blantyre, Malawi between 2006 and 2014.
A cohort of 1024 children treated for severe malnutrition (weight-for-length z-score < 70 % median and/or MUAC (mid-upper arm circumference) < 110 mm and/or bilateral oedema) at ages 5-168 months.
Faster weight gain during treatment (g/d) and after treatment (g/kg/day) was associated with lower risk of death (adjusted OR 0·99, 95 % CI 0·99, 1·00; and adjusted OR 0·91, 95 % CI 0·87, 0·94, respectively). In survivors (mean age 9 years), it was associated with greater hand grip strength (0·02, 95 % CI 0·00, 0·03) and larger HAZ (6·62, 95 % CI 1·31, 11·9), both indicators of better health. However, faster weight gain was also associated with increased waist:hip ratio (0·02, 95 % CI 0·01, 0·03), an indicator of later-life NCD risk. The clearest patterns of association were seen when defining PMGr based on weight gain in g/d during treatment and using the LCA method to describe growth patterns. Weight deficit at admission was a major confounder.
A complex pattern of benefits and risks is associated with faster PMGr. Both initial weight deficit and rate of weight gain have important implications for future health.
探讨重度营养不良治疗期间和治疗后(post-malnutrition growth, PMGr)的模式，并描述其与治疗后 7 年的生存和非传染性疾病(non-communicable disease, NCD)风险的关联。
基于多种时间点、体重、体重身长 z 评分和身高身长 z 评分（HAZ），得出了 6 项 PMGr 指标。三种分类方法包括不分类、五分位数和潜在类别分析（latent class analysis, LCA）。分析了与死亡率风险和 7 项 NCD 指标的关联。
2006 年至 2014 年期间，马拉维布兰太尔的二级数据。
年龄在 5-168 个月之间，患有严重营养不良（体重身长 z 评分 < 70%中位数和/或上臂中部周长（mid-upper arm circumference, MUAC）< 110 毫米和/或双侧水肿）的 1024 名儿童的队列。
治疗期间（g/d）和治疗后（g/kg/d）体重增长较快与死亡风险较低相关（校正比值比 0·99，95%置信区间 0·99，1·00；和校正比值比 0·91，95%置信区间 0·87，0·94）。在幸存者（平均年龄 9 岁）中，与更大的握力（0·02，95%置信区间 0·00，0·03）和更大的 HAZ（6·62，95%置信区间 1·31，11·9）相关，这两个指标均表示更好的健康状况。然而，体重增长较快也与腰围：臀围比增加有关（0·02，95%置信区间 0·01，0·03），这是晚年发生 NCD 风险的一个指标。当基于治疗期间每日体重增加来定义 PMGr，并使用 LCA 方法来描述生长模式时，关联模式最为明显。入院时的体重不足是一个主要的混杂因素。
PMGr 与一系列复杂的获益和风险相关。初始体重不足和体重增长速度对未来健康都有重要影响。
