title: Short children with a low midupper arm circumference respond to food supplementation: an observational study from Burkina Faso.
abstract: The management of children with moderate acute malnutrition (MAM) is based on food supplementation in outpatient programs. When midupper arm circumference (MUAC) is used as the sole admission criterion, it is common practice to exclude children with lengths <67 cm from treatment. The WHO calls for research to determine the treatment effect among children with MAM included by MUAC and aged ≥6 mo with lengths <67 cm.
  
  
  
  We hypothesized that among children given supplementary feeding based on an MUAC of 115-124 mm as the sole criterion, there would be no difference in growth rate between children <67 cm and those ≥67 cm in length at program admission.
  
  
  
  This was an observational study nested in a randomized trial that investigated the effectiveness of new formulations of corn-soy blend and lipid-based nutrient supplements. Children aged 6-23 mo were included if their MUAC was between 115 and 124 mm but with a weight-for-height z score (WHZ) ≥-2. This cohort was divided into 2 groups by length at admission: <67 cm ("short") and ≥67 cm ("long"). Linear mixed-effects models and regression models were used to compare gains in weight and MUAC while adjusting for intervention, season, sex, age, and site.
  
  
  
  Weight-gain velocity (expressed as g · kg(-1) · d(-1)) and MUAC-gain velocity (expressed as 0.01 mm · cm(-1) · d(-1)) were not different between short and long children. Weight-gain velocity was slightly higher in the shortest quartile of length (P = 0.03), whereas there was no effect modification by stunting across length quartiles (P = 0.32).
  
  
  
  We found no evidence of a difference in percentage of weight gain or weight-gain velocity during supplementary feeding in short or long children aged 6-23 mo. We recommend a policy change to include children <67 cm in supplementary feeding programs if their MUAC is between 115 and 124 mm and their WHZ is ≥-2. This could benefit millions of children currently excluded from supplementary feeding. This trial was registered at www.controlled-trials.com as ISRCTN42569496.
authors.affiliation: Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark; Médecins Sans Frontières-Denmark, Copenhagen, Denmark;
authors.forename: Christian
authors.identifier: 0000-0002-1987-781X
authors.initials: C
authors.lastname: Fabiansen
authors.affiliation: Alliance for International Medical Action, Dakar, Senegal; and.
authors.forename: Kevin Pq
authors.identifier: 0000-0002-7017-7464
authors.initials: KP
authors.lastname: Phelan
authors.affiliation: Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark;
authors.forename: Bernardette
authors.identifier: 0000-0002-7558-7032
authors.initials: B
authors.lastname: Cichon
authors.affiliation: Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark;
authors.forename: Christian
authors.identifier: 0000-0002-5095-0624
authors.initials: C
authors.lastname: Ritz
authors.affiliation: Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark; Department for International Health, University of Tampere School of Medicine, Tampere, Finland.
authors.forename: André
authors.identifier: 0000-0001-9390-8541
authors.initials: A
authors.lastname: Briend
authors.affiliation: Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark;
authors.forename: Kim F
authors.identifier: 0000-0003-0449-0839
authors.initials: KF
authors.lastname: Michaelsen
authors.affiliation: Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark;
authors.forename: Henrik
authors.identifier: 0000-0002-2848-2940
authors.initials: H
authors.lastname: Friis
authors.affiliation: Alliance for International Medical Action, Dakar, Senegal; and susan.shepherd@alima-ngo.org.
authors.forename: Susan
authors.identifier: 0000-0001-9515-4333
authors.initials: S
authors.lastname: Shepherd
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D001132:Arm; D049628:Body Size; D002050:Burkina Faso; D002657:Child Development; D015331:Cohort Studies; D003906:Developing Countries; D005500:Follow-Up Studies; D063105:Food Assistance; D006130:Growth Disorders / Q000209:etiology / Q000517:prevention & control; D007225:Infant Food; D007227:Infant Nutritional Physiological Phenomena; D044342:Malnutrition / Q000175:diagnosis / Q000178:diet therapy / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012720:Severity of Illness Index; D045730:Soy Foods; D015430:Weight Gain; D014944:World Health Organization
keywords: MUAC; moderate acute malnutrition; stunting; treatment; undernutrition