Weight and mid-upper arm circumference gain velocities during treatment of young children with severe acute malnutrition, a prospective study in Uganda

Jolly G K Kamugisha,Nicolette Nabukeera-Barungi,Christian Ritz,Ezekiel Mupere,Benedikte Grenov,André Briend,Betty Lanyero,Henrik Friis,Christian Mølgaard,Kim F Michaelsen,Harriet Nambuya-Lakor

doi:10.1186/s40795-021-00428-0

Jolly G K Kamugisha, Nicolette Nabukeera-Barungi + Show 9 more

Open Access

https://doi.org/10.1186/s40795-021-00428-0

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Abstract

BackgroundWeight gain is routinely monitored to assess hydration and growth during treatment of children with complicated severe acute malnutrition (SAM). However, changes in weight and mid-upper arm circumference (MUAC) gain velocities over time are scarcely described. We assessed weight and MUAC gain velocities in 6–59 mo-old children with complicated SAM by treatment phase and edema status.MethodsThis was a prospective study, nested in a randomized/probiotic trial (ISRCTN16454889). Weight and MUAC gain velocities were assessed by treatment phase and edema at admission using linear mixed-effects models.ResultsAmong 400 children enrolled, the median (IQR) age was 15.0 (11.2;19.2) months, 58% were males, and 65% presented with edema. During inpatient therapeutic care (ITC), children with edema vs no edema at admission had negative weight gain velocity in the stabilization phase [differences at day 3 and 4 were − 11.26 (95% CI: − 20.73; − 1.79) g/kg/d and − 13.09 (95% CI: − 23.15; − 3.02) g/kg/d, respectively]. This gradually changed into positive weight gain velocity in transition and eventually peaked at 12 g/kg/d early in the rehabilitation phase, with no difference by edema status (P > 0.9). During outpatient therapeutic care (OTC), overall, weight gain velocity showed a decreasing trend over time (from 5 to 2 g/kg/d), [difference between edema and non-edema groups at week 2 was 2.1 (95% CI: 1.0;3.2) g/kg/d]. MUAC gain velocity results mirrored those of weight gain velocity [differences were − 2.30 (95% CI: − 3.6; − 0.97) mm/week at week 1 in ITC and 0.65 (95% CI: − 0.07;1.37) mm/week at week 2 in OTC].ConclusionsWeight and MUAC gain velocities among Ugandan children with complicated SAM showed an increasing trend during transition and early in the rehabilitation phase, and a decreasing trend thereafter, but, overall, catch-up growth was prolonged. Further research to establish specific cut-offs to assess weight and MUAC gain velocities during different periods of rehabilitation is needed.

Highlights

Weight gain is routinely monitored to assess hydration and growth during treatment of children with complicated severe acute malnutrition (SAM)
Among 400 children with SAM enrolled into the parent ProbiSAM trial, the median (IQR) age was 15.0 (11.2; 19.2) months, 58% were males, and 65% presented with edema (Table 1)
Despite the huge variability in weight gain velocity in the stabilization phase, we find evidence of an increasing trend during transition and early in the rehabilitation phase in inpatient therapeutic care (ITC) followed by a decreasing trend, but, overall, there is elongated catch-up growth among Ugandan children with complicated SAM

Summary

Introduction

Weight gain is routinely monitored to assess hydration and growth during treatment of children with complicated severe acute malnutrition (SAM). We assessed weight and MUAC gain velocities in 6–59 moold children with complicated SAM by treatment phase and edema status. Children with complicated SAM are initially hospitalized for their treatment until stabilized, and are discharged to outpatient therapeutic care (OTC), to continue treatment alongside those with uncomplicated SAM [3, 4]. Weight gain velocity is computed less often and during rehabilitation phase only. It is categorized as poor if < 5 g/kg/d, moderate if 5–10 g/kg/d and good if > 10 g/kg/d [11, 12]

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