Low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment

被引：0

作者：

Briend A. ^{[1
,2
]}

Alvarez J.-L. ^{[3
,16
]}

Avril N. ^{[4
]}

Bahwere P. ^{[5
,6
,9
]}

Bailey J. ^{[7
]}

Berkley J.A. ^{[8
,21
]}

Binns P. ^{[5
,9
]}

Blackwell N. ^{[10
,23
,26
]}

Dale N. ^{[11
]}

Deconinck H. ^{[12
]}

Delchevalerie P. ^{[13
]}

Dent N. ^{[14
]}

Gallagher M. ^{[15
,24
]}

Guerrero S. ^{[3
,16
]}

Hanson K. ^{[17
]}

Kerac M. ^{[18
]}

Manary M. ^{[19
,20
]}

Mwangome M.K. ^{[8
,21
]}

Myatt M. ^{[22
]}

Phelan K.P.Q. ^{[10
,23
,26
]}

Pietzsch S. ^{[15
,24
]}

Ubach N.S. ^{[25
]}

Shepherd S. ^{[10
,23
,26
]}

Van Der Kam S. ^{[27
]}

Vargas A. ^{[28
]}

Whitney S. ^{[29
]}

机构：

[1] Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Lääkärinkatu 1, Tampere

[2] Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, Frederiksberg

[3] Action Against Hunger UK, London

[4] Médecins Sans Frontières, Genève 2

[5] Valid International, 35 Leopold Street, Oxford

[6] Center for Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels

[7] International Rescue Committee, 122 E. 42nd St, New York, 10168, NY

[8] KEMRI/Wellcome Trust Research Program, Kilifi

[9] Valid International, 35 Leopold Street, Oxford

[10] Alliance for International Medical Action, Dakar

[11] Tampere Centre for Child Health Research, University of Tampere, Tampere

[12] Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels

[13] Médecins Sans Frontières, Brussels

[14] Contrevoz

[15] Action Against Hunger US, New York, 10004, NY

[16] Action Against Hunger UK, London

[17] Médecins Sans Frontières, Paris

[18] London School of Hygiene and Tropical Medicine, London

[19] Department of Pediatrics, Washington University in St. Louis, St. Louis, MO

[20] School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre

[21] KEMRI/Wellcome Trust Research Program, Kilifi

[22] Brixton Health, Llawryglyn, Powys

[23] Alliance for International Medical Action, Dakar

[24] Action Against Hunger US, New York, 10004, NY

[25] Médecins Sans Frontières, Barcelona

[26] Alliance for International Medical Action, Dakar

[27] Médecins Sans Frontières, Amsterdam

[28] Accion Contra El Hambre, Madrid

[29] DG ECHO, Bureau Régional Afrique de l'Ouest, Dakar

来源：

BMC Nutrition | / 2卷 / 1期

关键词：

Mid-upper arm circumference; Mortality; Public health priority; Severe acute malnutrition; Weight-for-height;

D O I：

10.1186/s40795-016-0101-7

中图分类号：

学科分类号：

摘要：

Background: Severe acute malnutrition (SAM) is currently defined by the WHO as either a low mid-upper arm circumference (i.e. MUAC <115 mm), a low weight-for-height z-score (i.e. WHZ <- 3), or bilateral pitting oedema. MUAC and WHZ do not always identify the same children as having SAM. This has generated broad debate, as illustrated by the recent article by Grellety & Golden (BMC Nutr. 2016;2:10). Discussion: Regional variations in the proportion of children selected by each index seem mostly related to differences in body shape, including stuntedness. However, the practical implications of these variations in relation to nutritional status and also to outcome are not clear. All studies that have examined the relationship between anthropometry and mortality in representative population samples in Africa and in Asia have consistently showed that MUAC is more sensitive at high specificity levels than WHZ for identifying children at high risk of death. Children identified as SAM cases by low MUAC gain both weight and MUAC in response to treatment. The widespread use of MUAC has brought enormous benefits in terms of the coverage and efficiency of programs. As a large high-risk group responding to treatment, children with low MUAC should be regarded as a public health priority independently of their WHZ. Conclusion: While a better understanding of the mechanism behind the discrepancy between MUAC and WHZ is desirable, research in this area should not delay the implementation of programs aiming at effectively reducing malnutrition-related deaths by prioritising the detection and treatment of children with low MUAC. © 2016 The Author(s).

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