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Increasing WHO anthropometry targets may reduce relapses of malnutrition in children
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Higher anthropometry predicted long-term nutritional status in children with moderate acute malnutrition, regardless of therapy duration, according to new research data.
“These findings support a more sustainable recovery for malnourished children and move us another step closer to improving their care and long-term health,” Mark J. Manary, MD, from the department of pediatrics at Washington University in St. Louis, said in a press release. “While relapse rates remain a challenge we still need to overcome, this evidence should help us trim those rates. As it stands, far too many malnourished children relapse.”
Manary and colleagues performed a controlled prospective study of rural Malawian children (aged 6-59 months old) who recovered from moderate acute malnutrition as part of a randomized controlled clinical trial spanning 18 sites in southern Malawi from November 2009 and January 2011. They compared clinical outcomes 12 months after recovery of children fed for 12 weeks (n = 382) to those fed until they reached weight-for-height z scores greater than – 2 (n = 1,967).
“Even kids who weren’t treated for that long but quickly recovered their weight-for-height score or mid-upper arm circumference did just as well as the kids who were treated longer,” Indi Trehan, MD, MPH, from the department of pediatrics at Washington University and the department of pediatrics and child health at University of Malawi, said in the release. “That made us realize that the problem wasn’t so much that we weren’t treating kids long enough – it was that we weren’t treating them to the correct weight and [mid-upper arm circumference] targets. Both targets currently being used are insufficient. We need to adjust them higher.”
Children treated for 12 weeks were more likely to remain well-nourished at 12 months compared to those treated until they reached anthropometric goals (71% vs. 63%), an improvement of 8.7% (95% CI, 3.4%-13.9%). Furthermore, they were more likely to maintain more normal weight-for-height and height-for-age z scores, and tended to have lower rates of severe acute malnutrition (7% vs. 10%; P = .067) and death (2% vs. 4%; P = .082). However, mid-upper arm circumference and weight-for-height z score after treatment were the most important predictive factors regarding which children would remain well-nourished (both P < .001), and this increased in a dose-response manner.
“Establishing a higher threshold appears to be a better way to prevent relapse rather than treating all children for 12 weeks,” Trehan said in the release. “A higher threshold could provide a more optimal balance between conserving costs of treatment and scarce food resources and ensuring that as many children as possible don’t relapse following treatment.”
“This is crucial information for donor agencies and Health Ministries running supplementary feeding and other nutritional rehabilitation programmes, some of which may operate without considering available evidence,” David A. Forbes, MBBD, FRACP, from the School of Pediatrics & Child Health at University of Western Australia, and David R. Brewster, MD, MPH, FRACP, PhD, head of pediatrics at the Guido Valadares National Hospital in East Timor, wrote in an accompanying editorial. “We now have evidence that children with even moderate degrees of wasting should be supplemented until they reach higher [weight-for-height z scores] and [mid-upper arm circumference] endpoints than those currently recommended by WHO.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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