Body Composition and Catch-up in Height after Treatment of Malnourished Children

Full text: Background and Objectives: The use of enriched diets to promote rapid catch-up-growth and the delay in catch-up in length/height relative to catch-up in weight may be associated with excess adiposity and poor lean tissue deposition. We aimed to assess lean mass (LM) during treatment of Jamaican malnourished children and to investigate if stunted malnourished children remained stunted as adults. Methods: All participants were managed in hospital and in accordance with WHO guidelines. Diagnosis (marasmus, kwashiorkor, marasmic-kwashiorkor) was based on the Welcome Classification. LM was estimated from total body water(TBW)in 44 children (group 1), aged 3 to 32 months, during the stabilization period, mid catch-up growth and on achieving at least 90% of reference weight-for-length using deuterium dilution technique. Length-for-age (LAZ) and height-for-age (HAZ) Z-scores were determined in another group of 168 malnourished children (group 2) on admission, aged 3 to 33 months, and when they attained adulthood. LAZ was calculated using recent WHO child growth standards. Results: Data are mean ± SD. The participants included moderately and severely malnourished children based on weight-for-length Z-score (WLZ). In group 1, after initial stabilization intake increased to 685 ± 101 kJ/kg/d and 3.7 ± 0.6 g protein/kg/d resulting in rapid weight gain (16.5 ± 5.1 g/kg/d) and catch-up in weight over 20 ± 10 d. Consequently, WLZ at admission (non-oedematous: -3.0 ± 0.2; oedematous: -2.1 ± 0.2) improved to -0.48 ± 0.2. At recovery in weight, LM was consistent with reported values in normal children (71% to 92 % of body weight and 11 to 15 kg/m2) but the children remained stunted (LAZ: -3.3 ± 3.2). Insecurity of TBW measurement and estimating LM in the acute malnourished state and during rapid growth limits the ability to capture changes in lean and fat during rehabilitation. Similar to group 1, WLZ in group 2 was -3.2 ± 1.3 on admission; -0.6 ± 1 at recovery in weight and the children remained stunted (HAZ: -3.8 ± 2.1). On admission, 16% percent was moderately stunted (LAZ between –3 and –2) and 73% was severely stunted (LAZ > -3). Repeated measures analysis showed that LAZ is positively associated with adult HAZ (p = 0.00) controlling for age, sex and diagnosis. Whereas, most of the children were severely stunted on admission, by adulthood none were severely stunted but 34% had HAZ less than -1 and 6.5% remained moderately stunted. Conclusions: The results suggest that normal body composition is achieved with rapid catch-up in weight. However, reference body composition has not been clearly established. Majority of the stunted Jamaican children caught-up in height by adulthood. The factors contributing to persistent stunting in some children are not clear, but the results indicate the importance of periodic monitoring to ensure that adequate intake is maintained after recovery in weight. (author)