Document Type
Article
Department
Paediatrics and Child Health (East Africa)
Abstract
Background
Community-based treatment of acute malnutrition saves lives, but recovered children remain at risk of relapse post-discharge. Strategies to reduce this risk may include modification of anthropometric discharge criteria.
Objectives
This study aims to compare the diagnostic accuracy of anthropometric indices to reduce post-discharge relapse risk.
Methods
We searched PubMed from inception to June 2022. We included studies that enrolled children aged 0–59 mo successfully treated for severe or moderate acute malnutrition (SAM or MAM), assessed anthropometry at discharge, and had ≥1 follow-up assessment ≤6 mo post-discharge. Pooled sensitivity and specificity for anthropometric indices at discharge over multiple cutoffs were calculated using a bivariate mixed-effects model. Area under the pooled receiver operating curve (AUC) was estimated to measure diagnostic accuracy. “Pragmatic” cutoffs were defined as those maximizing AUC given both pooled sensitivity and pooled specificity ≥0.75. Primary outcomes were SAM relapse (SAM episode after successful SAM treatment: weight-for-height Z-score (WHZ) < −3, mid-upper arm circumference (MUAC) < 11.5 cm and/or edema) and MAM relapse (MAM episode after successful MAM treatment: −3 ≤ WHZ < −2 or 11.5 cm ≤ MUAC < 12.5 cm). Exposures were WHZ, MUAC, and weight-for-age Z-score (WAZ) at discharge.
Results
We included 34 studies from 16 countries contributing 21,989 children. WHZ at discharge had a higher AUC in predicting lower SAM and MAM relapse risk than MUAC or WAZ at discharge. None of the cutoffs examined met the study definition of “pragmatic.” The closest “pragmatic” cutoffs suggested that WHZ cutoffs of −1.4 and −1.8 or MUAC of 12.6 and 12.7 cm had the highest sensitivity and specificity in predicting lower SAM and MAM relapse risk.
Conclusions
Relapse risk is high after successful MAM/SAM treatment. Future research can consider optimization of anthropometric discharge criteria as a strategy to reduce post-discharge relapse risk, weighing the operational and financial tradeoffs associated with any modification.
Publication (Name of Journal)
The American Journal of Clinical Nutrition
DOI
https://doi.org/10.1016/j.ajcnut.2025.09.010
Recommended Citation
Bliznashka, L.,
Chaudhary, S.,
Rattigan, S.,
Isanaka, S.,
Adah, R.,
Ahmed, T.,
Alam, N.,
Alitanou, R.,
Bahwere, P.,
Nabwera, H.
(2025). Optimal anthropometric discharge criteria from treatment of wasting: meta-analysis of individual patient data from 34 studies. The American Journal of Clinical Nutrition, 1-11.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/601
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.