背景:可以使用身高体重Z评分(WHZ)和/或中上臂围(MUAC)来诊断严重的急性营养不良(SAM)。虽然有些人喜欢单独使用MUAC,重视其识别最需要营养护理的儿童的假定能力,在WHZ和MUAC缺陷不同的儿童中,功能严重程度和对治疗的生理反应仍未得到充分表征。
目的:我们旨在比较1)低MUAC和低WHZ的儿童对治疗的临床和生化反应,2)低MUAC,和3)仅低WHZ。
方法:多中心,观察性队列研究是在6-59个月的非水肿儿童中进行的,孟加拉国简单的SAM,布基纳法索,和利比里亚。在治疗期间收集人体测量和关键指标3次;指标包括临床状态,营养状况,生存能力,和血清瘦素,SAM死亡风险的生物标志物。
结果:联合MUAC和WHZ缺陷的儿童在治疗期间的瘦素水平增加比单独使用低MUAC的儿童更大,显示第二次访问增加了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,与仅MUAC低的儿童相比,联合缺陷组的体重增加速度高1.56g/kg/d(95%CI:0.38,2.75;P=0.03).合并缺陷的儿童缺铁和消瘦的发生率较高,而单独WHZ低和合并缺陷的儿童在治疗期间呼吸急促和肺炎的发生率较高。
结论:鉴于单独使用低WHZ的儿童和单独使用低MUAC的儿童的治疗反应相当,合并有缺陷的人在入院和治疗期间的脆弱性更大,我们的发现支持保留WHZ作为SAM的独立诊断和入院标准,在MUAC旁边。该试验已在www上注册。
结果:gov/study/NCT03400930作为NCT03400930。
BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
RESULTS: gov/study/NCT03400930 as NCT03400930.