This is the question that CHAIN authors, Martha Mwangome, Moses Ngari, Jay Berkley and others have sought to answer in their new paper entitled “Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo.” published in the American Journal of Clinical Nutrition (Am J Clin Nutr doi: 10.3945/ajcn.116.149815).
The nutritional demands of early infancy are significant considering how rapid growth combined with neurological and immune development must be sustained. Until recently, breastfeeding was thought to be adequate and so under 6-month infants were rarely scrutinized. However, early malnutrition exists and early detection and thus intervention can have important impact on the life trajectory of these children.
But how best to detect malnutrition in early infancy?
Current WHO guidelines describe malnutrition screening protocols for infants but recent research such as this paper from Mwangome et al. (2017) suggests that the diagnostic criteria and thresholds used may not be optimal. Their study looked at 2 882 infants admitted to hospital for care in Kilifi, Kenya, and, of these children, 1 405 were follow up after a year of being discharged. Overall, they found that the mid upper arm circumference (i.e. MUAC) and measures of weight-for-age were better predictors of inpatient and postdischarge mortality than the currently used criteria of weight for body length. They further identified a MUAC criteria of <11.0cm to be optimal for identifying those at most risk of death. This evidence together with other studies suggests that the global health community and health institutions should consider identifying infants at risk of death with these better performing diagnostic criterions. Infants with early malnutrition can thus better identified, and targeted for nutritional interventions.
See the open access article for full details and discussion.