Title :

Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo.

Abstract :

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.

Authors :

Mwangome, M., Ngari, M., Fegan, G., Mturi, N., Shebe, M., Bauni, E., Berkley, J.A.

PubMed link :

Journals :

Am J Clin Nutr. 2017