Does treatment of short or stunted children aged 6–59 months for severe acute malnutrition using ready to use therapeutic food make them overweight? Data from Malawi

Abstract

BackgroundUsing mid-upper arm circumference (MUAC) to identify severe acute malnutrition (SAM) tends to identify younger and stunted children compared to alternative anthropometric case-definitions. It has been asserted by some experts, without supporting evidence, that stunted children with low MUAC may have normal weight for height and treatment with ready to use therapeutic food (RUTF) will cause excess adiposity, placing the child at risk for non-communicable diseases (NCD) later in life. It is recommended that children aged less than 6 months should not be treated with RUTF. Height cut-offs are frequently used in SAM treatment programmes to identify children likely to be aged less than 6 months and thus not eligible for treatment with RUTF. This is likely to exclude some stunted children aged 6 months or older. This study examined whether stunted children aged 6 months or older with SAM, identified by MUAC, and treated with RUTF were overweight or had excess adiposity when discharged cured with a MUAC of greater than 125 mm.MethodsData was collected at Ministry of Health primary health care facilities delivering community based management of acute malnutrition (CMAM) services between February 2011 and March 2012 in Lilongwe District, Malawi on 258 children aged between 6 and 59 months enrolled in outpatient treatment for SAM with a MUAC less than 115 mm without medical complications irrespective of height on admission. 163 children were discharged as cured when MUAC was 125 mm or greater and there was an absence of oedema and the child was clinically well for 2 consecutive visits. MUAC, triceps skin fold (TSF) thickness and weight were measured at each visit. Height was measured on admission and discharge.ResultsNo study subjects (n = 0) were overweight or had excess adiposity when discharged cured with a MUAC greater than 125 mm.. There was a tendency towards a higher TSF-for-age (TSF/A) z-scores for severely stunted children compared to non-stunted children (Kruskal-Wallis chi-squared = 9.0675, p-value = 0.0107). For children admitted with a height less than 65 cm and those with a height of 65 cm or greater, there was no significant difference in TSF/A z-scores on discharge (Kruskal-Wallis chi-squared = 0.9219, p = 0.3370) or AFI/A z-scores on discharge (Kruskal-Wallis chi-squared = 0.0740, p = 0.7855).ConclusionsThese results should allay concerns that children aged 6 months and older and with a height less than 65 cm or with severe stunting will become overweight or obese as a result of treatment with RUTF in the outpatient setting using recommended MUAC admission and discharge criteria.Trial RegistrationISRCTN 92405176 Registered 15th May 2018. Retrospectively registered.

Decomposing the educational inequalities in the factors associated with severe acute malnutrition among under-five children in low- and middle-income countries

“…While the literature is replete with the factors predisposing children to SAM and other poor nutrition outcomes, decomposition of these factors on key variables significant to poor nutrition is scarce in the literature. The identified factors are largely individual and household factors such as food insecurity, inadequate care and feeding, unhealthy environment, poor access to education, child's age and sex, and mothers' employment status and income [1,[6][7][8][9][10][11][12]. In a recent hierarchical analysis of factors associated with SAM in 51 LMIC, Fagbamigbe et al identified maternal educational attainment, household wealth status and rural-urban differentials in the location of residence as the main determinants of whether a child has SAM or not [13].…”

“…Inequalities in maternal education remain key barriers to the occurrence of SAM among U5C [9,11,12,[15][16][17][18]. However, the underlying causes of educational inequalities in the development of SAM among U5C remain poorly operationalized, studied and understood.…”

Decomposing the educational inequalities in the factors associated with severe acute malnutrition among under-five children in Low- and Middle-Income Countries

“…The identified factors are largely individual and household factors such as food insecurity, inadequate care and feeding, unhealthy environment, poor access to education, child's age and sex, and mothers' employment status and income [1,[6][7][8][9][10][11][12]. In a recent hierarchical analysis of factors associated with SAM in 51 LMIC, Fagbamigbe et al identified maternal educational attainment, household wealth status and rural-urban differentials in the location of residence as the main determinants of whether a child has SAM or not [13].…”

Decomposing the educational inequalities in the factors associated with severe acute malnutrition among under-five children in Low- and Middle-Income Countries

“…The identified factors are largely individual and household factors such as food insecurity, inadequate care and feeding, unhealthy environment, poor access to education, child's age and sex, and mothers' employment status and income [1,[6][7][8][9][10][11][12].…”