Clinical and biochemical profiles in response to treatment of uncomplicated severe acute malnutrition : preliminary results from the multi-centric optidiag study

Background: The use of mid-upper arm circumference (MUAC) as the sole assessment tool for identifying children with severe acute malnutrition (SAM) is based on the assumption that those with low weight-for-height z-scores (WHZ) are at lower risk for morbidity and mortality than those with low MUAC. However, the pathophysiology and functional severity associated with different anthropometric phenotypes of SAM have not been well-characterized. Objective: The aim of this study was to describe and compare the response to medico-nutritional care in children with uncomplicated SAM identified among three anthropometric phenotypes: both low MUAC and low WHZ, low MUAC only, and low WHZ only. Methods: A multicentric cohort study was conducted in uncomplicated, non-edematous children aged 6-59 months with SAM in Bangladesh, Burkina Faso and Liberia. Alongside routine anthropometric measurements, a wide range of critical indicators of clinical and nutritional status and viability was collected at admission, two weeks and eight weeks, including serum leptin, a marker of adipose tissue reserves associated with mortality risk in SAM. Results: A total of 282 patients were included in the study (n=103 low MUAC only, n=89 low WHZ only, n=90 both deficits). Leptin levels at baseline were lower in children with combined defects in WHZ and MUAC and those with low WHZ only than in children with low MUAC alone. During eight weeks of treatment, the weight gain velocity and plasma leptin levels rose more quickly in children with combined defects than in children in the other two groups. At eight weeks those with combined defects and with low WHZ only had higher prevalence of pneumonia than children with low MUAC only. Leptin concentrations correlated far more strongly with WHZ (r=0.41, p<0.001) than with MUAC (r=0.12, p=0.074) at two weeks and eight weeks (r=0.46, r=0.32, respectively). On the other hand, the increase in leptin levels after eight weeks correlated more strongly with MUAC change (r=0.41, p<0.001) than with WHZ change (r=0.29, p<0.001). Conclusion: The correlation indicates that leptin has prognostic value for tracking adipose tissue accretion during the recovery process. Our previous analysis at admission showed that children with low WHZ only had equally or more severe deficits in nutritional and health status than children with low MUAC. The present analyses throughout recovery suggest that these children respond similarly to treatment compared with those with both deficits. Therefore, we suggest retaining WHZ as an independent criterion for diagnosing SAM, in line with current WHO recommendations. Presented at: The 11th Belgian Nutrition Society Annual Symposium; April 24th, 2023, Paleis der Academiën, Brussels, Belgium; “Nutrition and Physical Activity: from Basic Scientific to Daily Practice.” Presenting Author: Lishi Deng, MSc, PhD Candidate, [email protected]