Comparison of Clinical Characteristics and Treatment Outcomes of Children Selected for Treatment of Severe Acute Malnutrition Using Mid Upper Arm Circumference and/or Weight-for-Height Z-Score.
Comparison of Clinical Characteristics and Treatment Outcomes of Children Selected for Treatment of Severe Acute Malnutrition Using Mid Upper Arm Circumference and/or Weight-for-Height Z-Score.
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DOI：
10.1371/journal.pone.0137606
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Grais RF
中科院分区：
文献类型：
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作者：
Isanaka S;Guesdon B;Labar AS;Hanson K;Langendorf C;Grais RF
关于中上臂围(MUAC)措施在营养规划中发挥更大作用的争论仍在继续，但从允许儿童使用MUAC和/或身高体重(WHZ)的治疗性喂养计划转变为只允许儿童使用MUAC的新模式仍然复杂，因为关于MUAC和WHZ选择的儿童的临床特征和治疗反应的信息有限。为了扩大我们对MUAC和/或WHZ确定的治疗性喂养儿童的不同之处的理解，我们旨在调查MUAC和/或WHZ确定的治疗性喂养儿童在人口学、人体测量学、临床、实验室和治疗反应特征方面的差异。我们利用尼日尔农村地区一项针对无并发症的严重急性营养不良儿童的随机试验的二次数据，比较了将接受治疗性喂养计划的儿童和根据当前入院标准(WHZ；-3和/或MUAC<；115 mm)入院但将被排除在使用单一MUAC<；115 mm入院标准的计划之外的儿童。我们使用多元回归来评估两组之间的差异，对连续结果采用线性回归，对二分结果采用对数二项回归。我们发现，将被纳入MUAC<；115 mm治疗性喂养计划的儿童与目前有资格接受治疗性喂养但将被排除在仅MUAC计划之外的儿童在临床和实验室特征以及出院结果评估方面没有差异。在这一背景下，单一的人体测量入院标准MUAC<；115 mm在临床或实验室测量或计划结果方面不能很好地区分儿童。如果营养规划要使用单一的以MUAC为基础的入院治疗标准，进一步的研究和方案经验可以帮助在广泛的背景下确定最适当的标准，以最迫切需要治疗的儿童为目标。
Debate for a greater role of mid-upper arm circumference (MUAC) measures in nutritional programming continues, but a shift from therapeutic feeding programs admitting children using MUAC and/or weight-for-height Z (WHZ) to a new model admitting children using MUAC only remains complicated by limited information regarding the clinical profile and response to treatment of children selected by MUAC vs. WHZ. To broaden our understanding of how children identified for therapeutic feeding by MUAC and/or WHZ may differ, we aimed to investigate differences between children identified for therapeutic feeding by MUAC and/or WHZ in terms of demographic, anthropometric, clinical, and laboratory and treatment response characteristics. Using secondary data from a randomized trial in rural Niger among children with uncomplicated severe acute malnutrition, we compared children that would be admitted to a therapeutic feeding program that used a single anthropometric criterion of MUAC< 115 mm vs. children that are admitted under current admission criteria (WHZ< -3 and/or MUAC< 115 mm) but would be excluded from a program that used a single MUAC< 115 mm admission criterion. We assessed differences between groups using multivariate regression, employing linear regression for continuous outcomes and log-binomial regression for dichotomous outcomes. We found no difference in terms of clinical and laboratory characteristics and discharge outcomes evaluated between children that would be included in a MUAC< 115 mm therapeutic feeding program vs. children that are currently eligible for therapeutic feeding but would be excluded from a MUAC-only program. A single anthropometric admission criterion of MUAC < 115 mm did not differentiate well between children in terms of clinical or laboratory measures or program outcomes in this context. If nutritional programming is to use a single MUAC-based criterion for admission to treatment, further research and program experience can help to identify the most appropriate criterion in a broad range of contexts to target children in most urgent need of treatment.