Short malnourished children and fat accumulation with food supplementation

Christian Fabiansen; Kevin P Q Phelan; Bernardette Cichon; Charles W Yaméogo; Ann-Sophie Julie D Iuel-Brockdorff; Anura Kurpad; Jonathan C Wells; Christian Ritz; Suzanne Filteau; André Briend; Vibeke Bak Christensen; Kim F. Michaelsen; Susan Shepherd; Henrik Friis

doi:10.1542/peds.2018-0679

Short malnourished children and fat accumulation with food supplementation

Christian Fabiansen, Kevin P Q Phelan, Bernardette Cichon, Charles W Yaméogo, Ann-Sophie Julie D Iuel-Brockdorff, Anura Kurpad, Jonathan C Wells, Christian Ritz, Suzanne Filteau, André Briend, Vibeke Bak Christensen, Kim F. Michaelsen, Susan Shepherd, Henrik Friis

Lifecourse Nutrition & Health

7 Citations (Scopus)

Abstract

BACKGROUND: In moderate acute malnutrition programs, it is common practice to not measure mid-upper arm circumference (MUAC) of children whose length is <67 cm. This is based on expert opinion that supplementation of shorter children with low MUAC and weight-forheight z score ≥-2 may increase risk of excessive fat accumulation. Our aim was to assess if shorter children gain more fat than taller children when treated for moderate acute malnutrition diagnosed by low MUAC alone. METHODS: In this observational study, we included children aged 6 to 23 months with a MUAC between 115 and 125 mm and a weight-for-height z score ≥-2. On the basis of length at admission, children were categorized as short if <67 cm and long if ≥67 cm. Linear mixedeffects models were used to assess body composition on the basis of deuterium dilution and skinfold thickness. RESULTS: After 12 weeks of supplementation, there was no difference in change in fat mass index (-0.038 kg/m2, 95% confidence interval [CI]: -0.257 to 0.181, P = .74) or fat-free mass index (0.061 kg/m2, 95% CI: -0.150 to 0.271, P = .57) in short versus long. In absolute terms, the short children gained both less fat-free mass (-230 g, 95% CI: -355 to -106, P < .001) and fat mass (-97 g, 95% CI: -205 to 10, P = .076). There was no difference in changes in absolute subscapular and triceps skinfold thickness and z scores (P > .5). CONCLUSIONS: Short children with low MUAC do not gain excessive fat during supplementation. With these data, we support a recommendation for policy change to include all children ≥6 months with low MUAC in supplementary feeding programs, regardless of length. The use of length as a criterion for measuring MUAC to determine treatment eligibility should be discontinued in policy and practice.

Original language	English
Article number	e20180679
Journal	Pediatrics
Volume	142
Issue number	3
Number of pages	8
ISSN	0031-4005
DOIs	https://doi.org/10.1542/peds.2018-0679
Publication status	Published - Sept 2018

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Fabiansen, C., Phelan, K. P. Q., Cichon, B., Yaméogo, C. W., Iuel-Brockdorff, A.-S. J. D., Kurpad, A., Wells, J. C., Ritz, C., Filteau, S., Briend, A., Christensen, V. B., Michaelsen, K. F., Shepherd, S., & Friis, H. (2018). Short malnourished children and fat accumulation with food supplementation. Pediatrics, 142(3), Article e20180679. https://doi.org/10.1542/peds.2018-0679

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title = "Short malnourished children and fat accumulation with food supplementation",

abstract = "BACKGROUND: In moderate acute malnutrition programs, it is common practice to not measure mid-upper arm circumference (MUAC) of children whose length is <67 cm. This is based on expert opinion that supplementation of shorter children with low MUAC and weight-forheight z score ≥-2 may increase risk of excessive fat accumulation. Our aim was to assess if shorter children gain more fat than taller children when treated for moderate acute malnutrition diagnosed by low MUAC alone. METHODS: In this observational study, we included children aged 6 to 23 months with a MUAC between 115 and 125 mm and a weight-for-height z score ≥-2. On the basis of length at admission, children were categorized as short if <67 cm and long if ≥67 cm. Linear mixedeffects models were used to assess body composition on the basis of deuterium dilution and skinfold thickness. RESULTS: After 12 weeks of supplementation, there was no difference in change in fat mass index (-0.038 kg/m2, 95% confidence interval [CI]: -0.257 to 0.181, P = .74) or fat-free mass index (0.061 kg/m2, 95% CI: -0.150 to 0.271, P = .57) in short versus long. In absolute terms, the short children gained both less fat-free mass (-230 g, 95% CI: -355 to -106, P < .001) and fat mass (-97 g, 95% CI: -205 to 10, P = .076). There was no difference in changes in absolute subscapular and triceps skinfold thickness and z scores (P > .5). CONCLUSIONS: Short children with low MUAC do not gain excessive fat during supplementation. With these data, we support a recommendation for policy change to include all children ≥6 months with low MUAC in supplementary feeding programs, regardless of length. The use of length as a criterion for measuring MUAC to determine treatment eligibility should be discontinued in policy and practice.",

author = "Christian Fabiansen and Phelan, {Kevin P Q} and Bernardette Cichon and Yam{\'e}ogo, {Charles W} and Iuel-Brockdorff, {Ann-Sophie Julie D} and Anura Kurpad and Wells, {Jonathan C} and Christian Ritz and Suzanne Filteau and Andr{\'e} Briend and Christensen, {Vibeke Bak} and Michaelsen, {Kim F.} and Susan Shepherd and Henrik Friis",

note = "CURIS 2018 NEXS 302",

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doi = "10.1542/peds.2018-0679",

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T1 - Short malnourished children and fat accumulation with food supplementation

AU - Fabiansen, Christian

AU - Phelan, Kevin P Q

AU - Cichon, Bernardette

AU - Yaméogo, Charles W

AU - Iuel-Brockdorff, Ann-Sophie Julie D

AU - Kurpad, Anura

AU - Wells, Jonathan C

AU - Ritz, Christian

AU - Filteau, Suzanne

AU - Briend, André

AU - Christensen, Vibeke Bak

AU - Michaelsen, Kim F.

AU - Shepherd, Susan

AU - Friis, Henrik

N1 - CURIS 2018 NEXS 302

PY - 2018/9

Y1 - 2018/9

N2 - BACKGROUND: In moderate acute malnutrition programs, it is common practice to not measure mid-upper arm circumference (MUAC) of children whose length is <67 cm. This is based on expert opinion that supplementation of shorter children with low MUAC and weight-forheight z score ≥-2 may increase risk of excessive fat accumulation. Our aim was to assess if shorter children gain more fat than taller children when treated for moderate acute malnutrition diagnosed by low MUAC alone. METHODS: In this observational study, we included children aged 6 to 23 months with a MUAC between 115 and 125 mm and a weight-for-height z score ≥-2. On the basis of length at admission, children were categorized as short if <67 cm and long if ≥67 cm. Linear mixedeffects models were used to assess body composition on the basis of deuterium dilution and skinfold thickness. RESULTS: After 12 weeks of supplementation, there was no difference in change in fat mass index (-0.038 kg/m2, 95% confidence interval [CI]: -0.257 to 0.181, P = .74) or fat-free mass index (0.061 kg/m2, 95% CI: -0.150 to 0.271, P = .57) in short versus long. In absolute terms, the short children gained both less fat-free mass (-230 g, 95% CI: -355 to -106, P < .001) and fat mass (-97 g, 95% CI: -205 to 10, P = .076). There was no difference in changes in absolute subscapular and triceps skinfold thickness and z scores (P > .5). CONCLUSIONS: Short children with low MUAC do not gain excessive fat during supplementation. With these data, we support a recommendation for policy change to include all children ≥6 months with low MUAC in supplementary feeding programs, regardless of length. The use of length as a criterion for measuring MUAC to determine treatment eligibility should be discontinued in policy and practice.

AB - BACKGROUND: In moderate acute malnutrition programs, it is common practice to not measure mid-upper arm circumference (MUAC) of children whose length is <67 cm. This is based on expert opinion that supplementation of shorter children with low MUAC and weight-forheight z score ≥-2 may increase risk of excessive fat accumulation. Our aim was to assess if shorter children gain more fat than taller children when treated for moderate acute malnutrition diagnosed by low MUAC alone. METHODS: In this observational study, we included children aged 6 to 23 months with a MUAC between 115 and 125 mm and a weight-for-height z score ≥-2. On the basis of length at admission, children were categorized as short if <67 cm and long if ≥67 cm. Linear mixedeffects models were used to assess body composition on the basis of deuterium dilution and skinfold thickness. RESULTS: After 12 weeks of supplementation, there was no difference in change in fat mass index (-0.038 kg/m2, 95% confidence interval [CI]: -0.257 to 0.181, P = .74) or fat-free mass index (0.061 kg/m2, 95% CI: -0.150 to 0.271, P = .57) in short versus long. In absolute terms, the short children gained both less fat-free mass (-230 g, 95% CI: -355 to -106, P < .001) and fat mass (-97 g, 95% CI: -205 to 10, P = .076). There was no difference in changes in absolute subscapular and triceps skinfold thickness and z scores (P > .5). CONCLUSIONS: Short children with low MUAC do not gain excessive fat during supplementation. With these data, we support a recommendation for policy change to include all children ≥6 months with low MUAC in supplementary feeding programs, regardless of length. The use of length as a criterion for measuring MUAC to determine treatment eligibility should be discontinued in policy and practice.

U2 - 10.1542/peds.2018-0679

DO - 10.1542/peds.2018-0679

M3 - Journal article

C2 - 30143567

SN - 0031-4005

VL - 142

JO - Pediatrics

JF - Pediatrics

IS - 3

M1 - e20180679

ER -

Short malnourished children and fat accumulation with food supplementation

Abstract

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