Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo.
Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo.
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DOI：
10.3945/ajcn.116.149815
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Berkley JA
中科院分区：
文献类型：
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作者：
Mwangome M;Ngari M;Fegan G;Mturi N;Shebe M;Bauni E;Berkley JA
背景：6个月以下婴儿（U6M）营养不良的认识日益增加。目前的诊断标准使用身高体重z评分（WLZ），但2006年WHO标准排除了身高低于45 cm的婴儿。在年龄较大的儿童中，上臂围（MUAC）预测死亡率优于WLZ。结果也可能受到暴露于HIV和出生时的大小或胎龄的影响。WLZ、MUAC和其他指标的诊断阈值尚未针对U6 M婴儿的死亡风险进行充分评估。目的：目的是确定U6 M婴儿在住院时人体测量指标与住院和出院后死亡率风险之间的关系。设计：我们分析了肯尼亚Kilifi县医院（2007 - 2013）收治的U6 M婴儿队列的数据。主要结局为住院死亡和出院后1年以上随访期间死亡。我们计算了不同人体测量指标和阈值的住院死亡率和出院后死亡率的校正RR。采用受试者工作特征曲线评价判别值。结果：共收治婴幼儿2882例，其中死亡140例（4.9%），出院后随访1405例。其中，75例（5.3%）在1318儿童年的观察1年内死亡。MUAC和年龄别体重z评分（WAZ）预测住院和出院后死亡率优于WLZ（P <0.0001）。单个MUAC阈值<11.0 cm与随年龄变化的MUAC阈值相似（均P> 0.05），并且在住院和出院后死亡率方面均优于WLZ <-3（均P <0.001）。报道的出生时身材矮小并没有降低与人体测量指标相关的死亡风险。结论：死亡风险最高的U6 M婴儿最适合使用MUAC或WAZ。需要进一步研究潜在干预措施的有效性。
Background: There is an increasing recognition of malnutrition among infants under 6 mo of age (U6M). Current diagnosis criteria use weight-for-length z scores (WLZs), but the 2006 WHO standards exclude infants shorter than 45 cm. In older children, midupper arm circumference (MUAC) predicts mortality better than does WLZ. Outcomes may also be influenced by exposure to HIV and size or gestational age at birth. Diagnostic thresholds for WLZ, MUAC, and other indexes have not been fully evaluated against mortality risk among U6M infants. Objective: The aim was to determine the association of anthropometric indexes with risks of inpatient and postdischarge mortality among U6M infants recruited at the time of hospitalization. Design: We analyzed data from a cohort of U6M infants admitted to Kilifi County Hospital (2007–2013), Kenya. The primary outcomes were inpatient death and death during follow-up over 1 y after discharge. We calculated adjusted RRs for inpatient mortality and HRs for postdischarge mortality for different anthropometric measures and thresholds. Discriminatory value was assessed by using receiver operating characteristic curves. Results: A total of 2882 infants were admitted: 140 (4.9%) died in the hospital and 1405 infants were followed up after discharge. Of these, 75 (5.3%) died within 1 y during 1318 child-years of observation. MUAC and weight-for-age z score (WAZ) predicted inpatient and postdischarge mortality better than did WLZ (P < 0.0001). A single MUAC threshold of <11.0 cm performed similarly to MUAC thresholds that varied with age (all P > 0.05) and performed better than WLZ <−3 for both inpatient and postdischarge mortality (both P < 0.001). Reported small size at birth did not reduce the risk of death associated with anthropometric indexes. Conclusions: U6M infants at the highest risk of death are best targeted by using MUAC or WAZ. Further research into the effectiveness of potential interventions is required.