Location: Children's Nutrition Research CenterTitle: Development of acute malnutrition despite nutritional supplementation in Malawi
|KAIMILA, YANKHO - University Of Malawi|
|PITMAN, RYAN - Washington University|
|DIVALA, OSCAR - University Of Malawi|
|HENDRIXSON, D - Washington University|
|STEPHENSON, KEVIN - Washington University|
|AGAPOVA, SOPHIA - Washington University|
|TREHAN, INDI - Washington University|
|MALETA, KEN - University Of Malawi|
|MANARY, MARK - Children'S Nutrition Research Center (CNRC)|
Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/9/2018
Publication Date: 5/1/2019
Citation: Kaimila, Y., Pitman, R.T., Divala, O., Hendrixson, D.T., Stephenson, K.B., Agapova, S., Trehan, I., Maleta, K., Manary, M.J. 2019. Development of acute malnutrition despite nutritional supplementation in Malawi. Journal of Pediatric Gastroenterology and Nutrition. 68(5):734-737. https://doi.org/10.1097/MPG.0000000000002241.
Interpretive Summary: Acute malnutrition (AM) is associated with reduced nutrient intake; many interventions primarily focus on ensuring adequate community-wide nutritional intake. Utilizing data from two prospective, randomized control trials of complimentary feeding with supplemental legumes in two Malawian villages we document a high rate of AM and comparison of the two villages, Masenjere to Limera, demonstrate adequate and similar nutritional intake yet an increased rates of AM, stunting, chronic inflammation of the gut, and infectious symptoms in Masenjere. These findings suggest adequate nutrient intake does not entirely protect young children against AM. Additional research is needed.
Technical Abstract: Malnutrition in children is most often attributed to inadequate nutrient intake. Utilizing data from 2 prospective, randomized controlled trials of complimentary feeding with supplemental legumes (n=693, ages 6-24 months) in 2 Malawian villages, Masenjere, and Limera, we document a high rate 70/693 (10.1%) of acute malnutrition (AM). Risks for AM in this setting, as determined by Cox regression analysis, include study village (hazard ratio [HR] 3.0), prior malnutrition (HR 4.12), stunting (HR 2.87), and a marker of food insecurity (HR 1.89). Comparison of Masenjere to Limera demonstrate adequate and similar nutritional intake yet an increased rate of AM in Masenjere, 56 of 400 (14.0%) versus 14 of 293 (4.8%), and stunting, 140 of 400 (35%) versus 80 of 293 (27%), environmental enteric dysfunction 246 of 400 (71%) versus 181/293 (67%), and infectious symptoms (cough and diarrhea). Masenjere did have cleaner water and less food insecurity 200 of 399 (50.5%) versus 204 of 293 (69.6%). These findings suggest adequate complementary nutrient intake does not protect young children against AM.