Bwakura-Dangarembizi, Mutsa;
Dumbura, Cherlynn;
Ngosa, Deophine;
Majo, Florence D;
Piper, Joe D;
Sturgeon, Jonathan P;
Nathoo, Kusum J;
... HOPE-SAM study team; + view all
(2022)
Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia.
British Journal of Nutrition
10.1017/S0007114522004056.
(In press).
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Abstract
HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over one year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit z-score increase in impedance index and triceps skinfolds was associated with 48% (aHR 0.52, 95%CI 0.30,0.90) and 17% (aHR 0.83, 95%CI 0.71, 0.96) lower hazard of death/readmission respectively. HIV-positive versus HIV-negative children had lower gains in sum of skinfolds (mean difference -1.49, 95%CI -2.01, -0.97) and impedance index z-scores (-0.13, 95%CI -0.24, -0.01) over 52 weeks. Children with non-oedematous versus oedematous SAM had lower mean changes in sum of skinfolds (-1.47, 95%CI -1.97, -0.97) and impedance index z-scores (-0.23, 95%CI -0.36, -0.09). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children.
| Type: | Article |
|---|---|
| Title: | Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1017/S0007114522004056 |
| Publisher version: | https://doi.org/10.1017/S0007114522004056 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | HIV, Lean mass, fat mass, hospitalization, mortality, severe acute malnutrition |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10163091 |
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