Linear growth following complicated severe malnutrition

Research snapshot¹

Children presenting with severe acute malnutrition (SAM) are often also severely stunted. The purpose of this study was to evaluate linear growth and its determinants after medically complicated SAM. A secondary analysis was performed of clinical trial data from HIV-uninfected Kenyan children aged 2–59 months hospitalised with SAM. The outcome of interest was change in height/length-for-age z-score (HAZ) between enrolment and 12 months later. Exposures of interest were demographic, clinical, anthropometric characteristics and illness episodes during follow-up.

Among 1,169 children with HAZ values at month 12 (66% of those in the original trial), median (interquartile range) age 11 (7-17) months and mean (standard deviation) HAZ −2.87 (1.6) at enrolment, there was no change in mean HAZ between enrolment and month 12: −0.006Z (95% CI −0.07 to 0.05Z); 262 (23%) children experienced minimal HAZ change (within ±0.25 HAZ), 472 (40%) lost >0.25 and 435 (37%) gained >0.25 HAZ. After adjusting for regression to the mean, inpatient or outpatient episodes of diarrhoea and inpatient severe pneumonia during follow-up were associated with HAZ loss. Children born prematurely had greater linear growth than their term peers in this study, reaching a similar HAZ to other children after 12 months of follow-up. Not being cared for by the child’s biological parent (in this study these children were mostly in the care of children’s homes) was also associated with HAZ gain. Increases in mid-upper arm circumference (MUAC) and weight-for-age (WFA) were associated with HAZ gain and protected against HAZ loss. Increase in weight-for-height (WFH) was not associated with HAZ gain but protected against HAZ loss. No threshold of weight gain preceding linear catch-up growth was observed. The authors conclude that interventions to improve dietary quality and prevent illness over a longer period may provide opportunities to improve linear growth.