How severely underweight children with wasting respond to treatment?

Children with a weight-for-age z-score (WAZ) below -3 face a significant risk of death. Yet, this important indicator is not widely utilized in nutrition treatment programs. 

A new study investigated the prevalence, outcomes of treatment, and growth patterns of children with WAZ below -3, and compared the data to those of children with WAZ greater than or equal to -3 who received outpatient treatment for malnutrition and edema. The objective was to provide insights for future protocols.

This study analyzed secondary data from multiple sources. Logistic regression was used to compare the treatment outcomes. The analysis included data from 24,829 children across nine countries from 13 datasets. Recovery was defined as achieving a mid-upper-arm circumference of at least 12.5 cm, a weight-for-height z-score of -2 or higher, and the absence of edema within a 17-week period after admission. 

The results showed that 55% of wasted children had a WAZ below -3. Children admitted with WAZ below -3 had lower recovery rates (28.3% versus 48.7%), a higher risk of death (1.8% versus 0.7%), and a higher risk of transfer to inpatient care (6.2% versus 3.8%) compared to children with WAZ greater than or equal to -3. While children with WAZ below -3 had considerably lower anthropometric measurements at the beginning and end of treatment. Their patterns of anthropometric gains were similar to those with WAZ greater than or equal to -3. 

If moderately wasted children with WAZ below -3 were to be included in therapeutic programs alongside severely wasted children, the caseload would increase by 32%. 

Moreover, WAZ below -3 is common among severely and moderately wasted children (64% and 43%, respectively). Children with WAZ below -3 do not achieve conventional definitions of nutritional recovery as frequently as other wasted children despite their weight gain pattern being similar to other wasted children.

Children with wasting and WAZ below -3 likely require longer or more personalized treatment, particularly, those with moderate wasting who are typically ineligible for therapeutic feeding.

Children with severely low WAZ and edema likely require the greatest level of support due to the highest risk of mortality.

An intervention trial is necessary to further explore these hypotheses, including the participation of non-wasted children with WAZ below -3, who are currently absent in this secondary data analysis.

The findings supported existing evidence that children with wasting and WAZ below -3 are at even higher risk of mortality and do not achieve traditional definitions of nutritional recovery as promptly as other wasted children. 

Source: Odei Obeng‐Amoako GA, Stobaugh H, Wrottesley SV, et al. How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform future intervention studies. Maternal & Child Nutrition. 2023:e13434.