Abstract
BackgroundWeight-for-height Z-score (WHZ) and Mid Upper Arm Circumference (MUAC) are both commonly used as acute malnutrition screening criteria. However, there exists disparity between the groups identified as malnourished by them. Thus, here we aim to investigate the clinical features and linkage with chronicity of the acute malnutrition cases identified by either WHZ or MUAC. Besides, there exists evidence indicating that fat restoration is disproportionately rapid compared to that of muscle gain in hospitalized malnourished children but related research at community level is lacking. In this study we suggest proxy measure to inspect body composition restoration responding to malnutrition management among the malnourished children.MethodsThe data of this study is from World Vision South Sudan’s emergency nutrition program from 2006 to 2012 (4443 children) and the nutrition survey conducted in 2014 (3367 children). The study investigated clinical presentations of each type of severe acute malnutrition (SAM) by WHZ (SAM-WHZ) or MUAC (SAM-MUAC), and analysed correlation between each malnutrition and chronic malnutrition. Furthermore, we explored the pattern of body composition restoration during the recovery phase by comparing the relative velocity of MUAC3 with that of weight gain.ResultsAs acutely malnourished children identified by MUAC more often share clinical features related to chronic malnutrition and minimal overlapping with malnourished children by WHZ, Therefore, MUAC only screening in the nutrition program would result in delayed identification of the malnourished children.ConclusionsThe relative velocity of MUAC3 gain was suggested as a proxy measure for volume increase, and it was more prominent than that of weight gain among the children with SAM by WHZ and MUAC over all the restoring period. Based on this we made a conjecture about dominant fat mass gain over the period of CMAM program. Also, considering initial weight gain could be ascribed to fat mass increase, the current discharge criteria would leave the malnourished children at risk of mortality even after treatment due to limited restoration of muscle mass. Given this, further research should be followed including assessment of body composition for evidence to recapitulate and reconsider the current admission and discharge criteria for CMAM program.
Highlights
Weight-for-height Z-score (WHZ) and Mid Upper Arm Circumference (MUAC) are both commonly used as acute malnutrition screening criteria
Clinical features of each type of acute malnutrition The Venn diagram (Fig. 2) of the community data shows that the prevalence of severe acute malnutrition (SAM)-MUAC is similar to that of Sever Acute Malnutrition identified by WHZ (SAM-WHZ) (4.8 vs. 4.5%, respectively), which is the same for Global Acute Malnutrition (GAM, defined as MUAC < 125 mm or WHZ < − 2) (12.9% ± 1.3% vs. 17.6% ± 1.1% respectively)
The median age for children admitted by SAM-WHZ to the malnutrition program is 29 months, which is greater than that of children admitted by SAM-MUAC, 18 months
Summary
Weight-for-height Z-score (WHZ) and Mid Upper Arm Circumference (MUAC) are both commonly used as acute malnutrition screening criteria. MUAC tends to replace WHZ and to be considered as a single indicator in the community together with bipedal oedema for malnutrition screening [7, 8]. This trend is rationalized by MUAC’s superiority in predicting mortality and has other benefits such as simplicity and accuracy of the measurement, easy training and its attribute of being less affected by dehydration [6, 7, 9,10,11,12,13,14]. The prognostic accuracy of MUAC to predict mortality is not inferior to that of combined screening by both MUAC and WHZ or even MUAC z-score for age [14, 15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
