Airbel Impact Lab, International Rescue Committee, New York, New York, USA.
Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
Matern Child Nutr. 2024 Oct;20(4):e13693. doi: 10.1111/mcn.13693. Epub 2024 Aug 5.
Treatment of severe acute malnutrition aims at producing quick catch-up growth in children to decrease their short-term mortality risk. The extent to which catch-up growth is influenced by the amount of energy provided is unclear. This study assessed whether energy provided at admission is associated with catch-up ponderal growth among children with mid-upper arm circumference (MUAC) < 115 mm at admission. We conducted a secondary data analysis an operational cohort in Mali. The children were treated with a simplified protocol providing 1000 kcal/day of therapeutic food until MUAC ≥ 115 mm was achieved for two consecutive weeks and 500 kcal/day thereafter until discharge with MUAC ≥ 125 mm for two consecutive weeks. Linear mixed-effects regression models were fitted to assess the relationship between energy provided at admission (kcal/kg/day) with weight gain velocity (g/kg/day) (primary outcome), change in MUAC -for-age z-score and change in weight-for-age z-score. Unadjusted models and models adjusted for sex, age, seasonality and MUAC at admission were fitted. Both models included the study site as a random effect. A 10 kcal/kg/day increase in energy provided at admission was associated with increments in all outcomes; for weight gain velocity, the mean (95% CI) increment was 0.340 [0.326, 0.354] g/kg/day and 0.466 [0.446, 0.485] g/kg/day in the unadjusted and adjusted analysis, respectively. A positive relationship exists between energy provided at admission and catch-up ponderal growth in children with MUAC < 115 mm treated using a simplified protocol. Determining the ideal weight gain rate remains essential for assessing the benefits and risks of increased energy intake during treatment.
治疗严重急性营养不良的目的是使儿童迅速赶上生长，降低其短期死亡率风险。提供的能量对追赶生长的影响程度尚不清楚。本研究评估了入院时提供的能量与入院时中上臂围（MUAC）<115mm的儿童的追赶性体重增长之间的关系。我们对马里的一个操作队列进行了二次数据分析。该方案采用简化方案治疗，为儿童提供 1000kcal/天的治疗性食物，直到 MUAC连续两周≥115mm，然后提供 500kcal/天，直到 MUAC连续两周≥125mm出院。采用线性混合效应回归模型评估入院时提供的能量（kcal/kg/天）与体重增长速度（g/kg/天）（主要结局）、MUAC-年龄 z 评分变化和体重-年龄 z 评分变化之间的关系。拟合了未调整模型和调整性别、年龄、季节性和入院时 MUAC 的模型。两个模型都将研究地点作为随机效应纳入。入院时提供的能量增加 10kcal/kg/天，所有结局均有增加；对于体重增长速度，未调整和调整分析的平均（95%CI）增量分别为 0.340[0.326, 0.354]g/kg/天和 0.466[0.446, 0.485]g/kg/天。在使用简化方案治疗 MUAC<115mm 的儿童中，入院时提供的能量与追赶性体重增长之间存在正相关关系。确定理想的体重增长率对于评估治疗期间增加能量摄入的益处和风险仍然至关重要。
