TY - JOUR
T1 - Clinical and biochemical markers of risk in uncomplicated severe acute malnutrition
AU - Dailey-Chwalibóg, Trenton
AU - Freemark, Michael
AU - Muehlbauer, Michael
AU - Roberfroid, Dominique
AU - Kemokai, Issa A.
AU - Mostak, Md Rayhan
AU - Alim, Md Abdul
AU - Khan, Murad Md Shamsher Tabris
AU - Khan, Md Abul Hashem
AU - Bawo, Luke
AU - Dunbar, Nelson K.
AU - Taylor, Curtis H.
AU - Fouillet, Helene
AU - Huneau, Jean Francois
AU - Kolsteren, Patrick
AU - Guesdon, Benjamin
N1 - Funding Information:
FUNDING: The data presented in this article are part of the OptiDiag study, which is funded by Action Contre la Faim France with financial support from the European Commission’s Civil Protection and Humanitarian Aid Operations Enhanced Response Capacity (grant ECHO/ERC/BUD/2015/91002) and the Humanitarian Innovation Fund, a program managed by Enhanced Learning and Research for Humanitarian Assistance. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.
Funding Information:
FINANCIAL DISCLOSURE: Dr Dailey-Chwalibóg reports grants from the Humanitarian Innovation Fund (HIF) at Enhanced Learning and Research for Humanitarian Assistance (ELRHA), the Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), the Foundation Action Contre la Faim, and the Association Nationale Recherche Technologie (ANRT) for a Convention Industrielle de Formation par la REcherche (CIFRE) grant, provided to Action Contre la Faim France and AgroParisTech for the conduct of the study. Dr Guesdon reports grants from the HIF, DH-ECHO, the Foundation Action Contre la Faim, and the ANRT provided to Action Contre la Faim France for the conduct of the study. Dr Freemark reports grants from the HIF and DG-ECHO during the conduct of the study; the other authors have indicated they have no financial relationships relevant to this article to disclose.
Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics
PY - 2021/6/1
Y1 - 2021/6/1
N2 - BACKGROUND AND OBJECTIVES: Use of mid-upper arm circumference (MUAC) as a single screening tool for severe acute malnutrition (SAM) assumes that children with a low weight-for-height z score (WHZ) and normal MUAC have lower risks of morbidity and mortality. However, the pathophysiology and functional severity associated with different anthropometric phenotypes of SAM have never been well characterized. We compared clinical characteristics, biochemical features, and health and nutrition histories of nonedematous children with SAM who had (1) low WHZ only, (2) both low WHZ and low MUAC, or (3) low MUAC only. METHODS: In Bangladesh, Burkina Faso, and Liberia, we conducted a multicentric cohort study in uncomplicated, nonedematous children with SAM and low MUAC only (n = 161), low WHZ only (n = 138), or a combination of low MUAC and low WHZ (n = 152). Alongside routine anthropometric measurements, we collected a wide range of critical indicators of clinical and nutritional status and viability; these included serum leptin, an adipocytokine negatively associated with mortality risk in SAM. RESULTS: Median leptin levels at diagnosis were lower in children with low WHZ only (215.8 pg/ mL; P,.001) and in those with combined WHZ and MUAC deficits (180.1 pg/mL; P,.001) than in children with low MUAC only (331.50 pg/mL). The same pattern emerged on a wide range of clinical indicators, including signs of severe wasting, dehydration, serum ferritin levels, and caretaker-reported health deterioration, and was replicated across study sites. CONCLUSIONS: Illustrative of the likely heterogeneous functional severity of the different anthropometric phenotypes of SAM, our results confirm the need to retain low WHZ as an independent diagnostic criterion.
AB - BACKGROUND AND OBJECTIVES: Use of mid-upper arm circumference (MUAC) as a single screening tool for severe acute malnutrition (SAM) assumes that children with a low weight-for-height z score (WHZ) and normal MUAC have lower risks of morbidity and mortality. However, the pathophysiology and functional severity associated with different anthropometric phenotypes of SAM have never been well characterized. We compared clinical characteristics, biochemical features, and health and nutrition histories of nonedematous children with SAM who had (1) low WHZ only, (2) both low WHZ and low MUAC, or (3) low MUAC only. METHODS: In Bangladesh, Burkina Faso, and Liberia, we conducted a multicentric cohort study in uncomplicated, nonedematous children with SAM and low MUAC only (n = 161), low WHZ only (n = 138), or a combination of low MUAC and low WHZ (n = 152). Alongside routine anthropometric measurements, we collected a wide range of critical indicators of clinical and nutritional status and viability; these included serum leptin, an adipocytokine negatively associated with mortality risk in SAM. RESULTS: Median leptin levels at diagnosis were lower in children with low WHZ only (215.8 pg/ mL; P,.001) and in those with combined WHZ and MUAC deficits (180.1 pg/mL; P,.001) than in children with low MUAC only (331.50 pg/mL). The same pattern emerged on a wide range of clinical indicators, including signs of severe wasting, dehydration, serum ferritin levels, and caretaker-reported health deterioration, and was replicated across study sites. CONCLUSIONS: Illustrative of the likely heterogeneous functional severity of the different anthropometric phenotypes of SAM, our results confirm the need to retain low WHZ as an independent diagnostic criterion.
UR - http://www.scopus.com/inward/record.url?scp=85107711748&partnerID=8YFLogxK
U2 - 10.1542/peds.2020-027003
DO - 10.1542/peds.2020-027003
M3 - Article
C2 - 34021063
AN - SCOPUS:85107711748
SN - 0031-4005
VL - 147
JO - Pediatrics
JF - Pediatrics
IS - 6
M1 - e2020027003
ER -
