Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
Department of Expertise and Advocacy, Action Contre la Faim, Paris, France.
Am J Clin Nutr. 2024 Sep;120(3):570-582. doi: 10.1016/j.ajcnut.2024.05.029. Epub 2024 Aug 8.
Severe acute malnutrition (SAM) can be diagnosed using weight-for-height Z-score (WHZ) and/or mid-upper arm circumference (MUAC). Although some favor using MUAC alone, valuing its presumed ability to identify children at greatest need for nutritional care, the functional severity and physiological responses to treatment in children with varying deficits in WHZ and MUAC remain inadequately characterized.
We aimed to compare clinical and biochemical responses to treatment in children with 1) both low MUAC and low WHZ, 2) low MUAC-only, and 3) low WHZ-only.
A multicenter, observational cohort study was conducted in children aged 6-59 mo with nonedematous, uncomplicated SAM in Bangladesh, Burkina Faso, and Liberia. Anthropometric measurements and critical indicators were collected 3 times during treatment; metrics included clinical status, nutritional status, viability, and serum leptin, a biomarker of mortality risk in SAM.
Children with combined MUAC and WHZ deficits had greater increases in leptin levels during treatment than those with low MUAC alone, showing a 34.4% greater increase on the second visit (95% confidence interval [CI]: 7.6%, 43.6%; P = 0.02) and a 34.3% greater increase on the third visit (95% CI: 13.2%, 50.3%; P = 0.01). Similarly, weight gain velocity was higher by 1.56 g/kg/d in the combined deficit group (95% CI: 0.38, 2.75; P = 0.03) compared with children with low MUAC-only. Children with combined deficits had higher rates of iron deficiency and wasting while those with low WHZ alone and combined deficits had higher rates of tachypnea and pneumonia during treatment.
Given the comparable treatment responses of children with low WHZ alone and those with low MUAC alone, and the greater vulnerability at admission and during treatment in those with combined deficits, our findings support retaining WHZ as an independent diagnostic and admission criterion of SAM, alongside MUAC. This trial was registered at www.
gov/study/NCT03400930 as NCT03400930.
严重急性营养不良（SAM）可通过体重与身高的 Z 评分（WHZ）和/或中上臂围（MUAC）来诊断。尽管有些人倾向于单独使用 MUAC，认为它能够识别出最需要营养护理的儿童，但 WHZ 和 MUAC 不同程度降低的儿童的功能严重程度和对治疗的生理反应仍未得到充分描述。
我们旨在比较 WHZ 和 MUAC 均降低、仅 MUAC 降低和仅 WHZ 降低的儿童在治疗中的临床和生化反应。
在孟加拉国、布基纳法索和利比里亚，对 6-59 月龄非水肿、非复杂性 SAM 患儿进行了一项多中心、观察性队列研究。在治疗期间进行了 3 次人体测量学测量和关键指标的测量；指标包括临床状态、营养状况、生存能力和血清瘦素，瘦素是 SAM 死亡率风险的生物标志物。
与仅 MUAC 降低的儿童相比，同时存在 MUAC 和 WHZ 缺陷的儿童在治疗过程中瘦素水平的增加更大，第二次就诊时增加了 34.4%（95%置信区间[CI]：7.6%，43.6%；P=0.02），第三次就诊时增加了 34.3%（95%CI：13.2%，50.3%；P=0.01）。同样，联合缺陷组的体重增加速度也更高，每天增加 1.56 克/公斤（95%CI：0.38，2.75；P=0.03），与仅 MUAC 降低的儿童相比。同时存在 MUAC 和 WHZ 缺陷的儿童在治疗期间铁缺乏和消瘦的发生率更高，而仅 WHZ 降低和同时存在 MUAC 和 WHZ 缺陷的儿童在治疗期间呼吸急促和肺炎的发生率更高。
鉴于单独存在 WHZ 和 MUAC 缺陷的儿童治疗反应相当，以及同时存在联合缺陷的儿童入院和治疗期间的脆弱性更大，我们的研究结果支持保留 WHZ 作为 SAM 的独立诊断和入院标准，与 MUAC 并存。该试验在 www.clinicaltrials.gov/study/NCT03400930 注册，注册号为 NCT03400930。
