Nalwanga Damalie, Musiime Victor, Kiguli Sarah, Olupot-Olupot Peter, Alaroker Florence, Opoka Robert, Tagoola Abner, Mnjalla Hellen, Mogaka Christabel, Nabawanuka Eva, Giallongo Elisa, Karamagi Charles, Briend André, Maitland Kathryn
Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
Makerere University Lung Institute, Kampala, Uganda.
BMC Nutr. 2024 Sep 30;10(1):130. doi: 10.1186/s40795-024-00939-6.
Pneumonia remains the leading cause of mortality among children under 5 years. Poor nutritional status increases pneumonia mortality. Nutritional status assessed by anthropometry alone does not provide information on which body composition element predicts survival. Body composition proxy measures including arm-fat-area (AFA), arm-muscle-area (AMA), and arm-muscle-circumference (AMC) could be useful predictors.
To compare the ability of fat and muscle mass indices to predict 6-month survival among children with severe pneumonia.
This prospective cohort study was nested in the COAST-Nutrition trial (ISRCTN10829073, 06/06/2018) conducted between June 2020 and October 2022 in Uganda and Kenya. We included children aged 6-59 months hospitalized for severe pneumonia with hypoxemia. Children with severe malnutrition, known chronic lung or cardiac diseases were excluded. Anthropometry and clinical status were assessed at enrolment and at follow-up to day 180. We examined Receiver Operator Characteristic (ROC) curves of fat and muscle mass indices with 6-month survival as the outcome, and compared the areas under the curve (AUCs) using chi-square tests. Cox survival analysis models assessed time-to-mortality.
We included 369 participants. The median age was 15-months (IQR 9, 26), and 59.4% (219/369) of participants were male. The baseline measurements were: median MUAC 15.0 cm (IQR 14.0,16.0); arm-fat-area 5.6cm (IQR 4.7, 6.8); arm-muscle-area 11.4cm (IQR 10.0, 12.7); and arm-muscle-circumference 12.2 cm (IQR 11.5, 12.9). Sixteen (4.3%) participants died and 4 (1.1%) were lost-to-follow-up. The AUC for Arm-Fat-Area was not significantly higher than that for Arm-Muscle-Area and Arm-Muscle-Circumference [AUC 0.77 (95%CI 0.64-0.90) vs. 0.61 (95%CI 0.48-0.74), p = 0.09 and 0.63 (95%CI 0.51-0.75), p = 0.16 respectively], but was not statistically different from MUAC (AUC 0.73 (95%CI 0.62-0.85), p = 0.47). Increase in Arm-Fat-Area and Arm-Muscle-Circumference significantly improved survival [aHR 0.40 (95%CI 0.24-0.64), p = < 0.01 and 0.59 (95%CI 0.36-1.06), p = 0.03 respectively]. Survival prediction using Arm-Fat-Area was not statistically different from that of MUAC (p = 0.54).
Muscle mass did not predict 6-month survival better than fat mass in children with severe pneumonia. Fat mass appears to be a better predictor. Effects of fat and muscle could be considered for prognosis and targeted interventions.
肺炎仍然是5岁以下儿童死亡的主要原因。营养状况不佳会增加肺炎死亡率。仅通过人体测量评估营养状况无法提供关于哪种身体成分要素可预测生存情况的信息。包括手臂脂肪面积（AFA）、手臂肌肉面积（AMA）和手臂肌肉周长（AMC）在内的身体成分替代指标可能是有用的预测指标。
比较脂肪和肌肉量指数预测重症肺炎患儿6个月生存率的能力。
这项前瞻性队列研究嵌套于2020年6月至2022年10月在乌干达和肯尼亚进行的COAST-营养试验（ISRCTN10829073，2018年6月6日）。我们纳入了因重症肺炎伴低氧血症住院的6至59个月大的儿童。排除患有严重营养不良、已知慢性肺部或心脏疾病的儿童。在入组时和随访至第180天时评估人体测量和临床状况。我们以6个月生存率为结局，检查了脂肪和肌肉量指数的受试者工作特征（ROC）曲线，并使用卡方检验比较了曲线下面积（AUC）。Cox生存分析模型评估死亡时间。
我们纳入了369名参与者。中位年龄为15个月（四分位间距9，26），59.4%（219/369）的参与者为男性。基线测量值为：中位上臂围（MUAC）15.0厘米（四分位间距14.0，16.0）；手臂脂肪面积5.6厘米（四分位间距4.7，6.8）；手臂肌肉面积11.4厘米（四分位间距10.0，12.7）；手臂肌肉周长12.2厘米（四分位间距11.5，12.9）。16名（4.3%）参与者死亡，4名（1.1%）失访。手臂脂肪面积的AUC并不显著高于手臂肌肉面积和手臂肌肉周长的AUC[分别为0.77（95%置信区间0.64 - 0.90）对0.61（95%置信区间0.48 - 0.74），p = 0.09和0.63（95%置信区间0.51 - 0.75），p = 0.16]，但与MUAC无统计学差异（AUC 0.73（95%置信区间0.62 - 0.85），p = 0.47）。手臂脂肪面积和手臂肌肉周长的增加显著改善了生存率[调整后风险比（aHR）分别为0.40（95%置信区间0.24 - 0.64），p = < 0.01和0.59（95%置信区间0.36 - 1.06），p = 0.03]。使用手臂脂肪面积进行生存预测与MUAC无统计学差异（p = 0.54）。
在重症肺炎患儿中，肌肉量预测6个月生存率并不优于脂肪量。脂肪量似乎是更好的预测指标。在预后和针对性干预中可考虑脂肪和肌肉的影响。
