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Does Low MUAC treated with RUTF result in children becoming obese?

This question was posted the Management of wasting/acute malnutrition forum area and has 3 replies.

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Mark Myatt

Frequent user

13 Dec 2018, 12:47

Using MUAC to identify SAM cases tends to identify more younger and stunted children compared to WHZ. Concerns have been expressed that stunted children with low MUAC may have normal weight for height and that treatment with RUTF will lead to excess adiposity placing children at risk for non-communicable diseases later in life. This may be a particular issue with programs that discharge on MUAC > 125 mm. These concerns have to be taken seriously.

This article present a study that examined whether stunted children aged six months or older with SAM, identified by MUAC, and treated with RUTF were overweight or had excess adiposity when discharged cured with MUAC > 125mm. The study found that No study subjects (0 of 163) were overweight or had excess adiposity when discharged cured with MUAC > 125 mm. The results should allay concerns that low MUAC children treated with RUTF become overweight or obese as a result of treatment.

Importantly, height-based eligibility criteria will lead to young children with concurrent wasting and stunting and at high risk of death if untreated being excluded from treatment. Height-based eligibility criteria should, therefore, be abandoned.


Frequent user

13 Dec 2018, 14:53

I am currently in the double burden of malnutrition in Vienna and thought I should share the following abstract. Please contact Dr. FABIANSEN, Christian whose contact is below the abstract.

TITLE: Short children with a low MUAC do not gain excessive fat with food supplementation: an observational study from Burkina Faso

Introduction: Children with moderate acute malnutrition (MAM) in many settings receive food supplementation through outpatient programs. It is common practice to avoid measurement of mid-upper arm circumference (MUAC) of children, whose length is below a certain threshold (67 or 65 cm). Thus, even if short children have low MUAC they are excluded from malnutrition programs.
This seems based on expert opinion that supplementation of shorter children with weight-forheight z-score (WHZ) ≥-2 may increase risk of excessive fat accumulation during treatment and later risk of non-communicable diseases. We have previously shown that ponderal growth rates are similar in short and longer children with low MUAC. To what extent there is difference in fat accumulation has not been assessed.
Objective: To assess if short children gain more fat than longer children when treated for MAM diagnosed by low MUAC.
Method: This was an observational study nested in a randomized nutrition trial. Children aged 6-23 months were included in this sub-study if their MUAC was between 115-125 mm, but WHZ ≥-2. Based on length at admission the children were categorized as SHORT if <67 cm and LONG if ≥67 cm. Linear mixed-effects models with site-specific random effects were used to compare changes in body composition, based on deuterium dilution, and skinfold thickness while adjusting
for month of admission, baseline measure, intervention, sex and age.
Results: Following 12 weeks of supplementation, there was no difference in change in fat mass index (-0.038 kg/m2, 95%CI -0.257; 0.181, p=0.74) or fat-free mass index (0.061 kg/m2, 95%CI -0.150; 0.271; p=0.57) in SHORT vs LONG. In absolute terms, the SHORT children gained both less fat-free mass (-230 g, 95%CI: -355, -106, P<0.001) and less fat mass (-97 g, 95%CI -205, 10, p=0.076). There were no difference in changes in absolute subscapular and triceps skinfold thickness and z-scores
(all p>0.5).
Conclusions: SHORT children with low MUAC do not gain excessive fat during supplementation. These data support a recommendation for policy change to include all children ≥6 months with low MUAC in supplementary feeding programs, regardless of length. The use of length as a criterion for measuring MUAC to determine treatment eligibility should be discontinued in policy and practice wherever such restrictions exist

Institution: Department of Nutrition, Exercise and Sports, University of Copenhagen/ MSF-DK/ALIMA
Country: Denmark, Senegal
Primary author(s) : Dr. FABIANSEN, Christian (Department of Nutrition, Exercise and Sports,
University of Copenhagen, Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark. Médecins Sans Frontières - Denmark, Dronningensgade 68, 3, 1420 Copenhagen, ALIMA, Route de l’Aéroport, Rue NG 96
BP: 15530. Dakar, Sénégal)
December 4, 2018 Page 6
Book of Abstracts Session 7 IAEA International Symposium on Understanding the Double Burden of Malnutrition for

Mark Myatt

Frequent user

13 Dec 2018, 15:19

Thanks for this. The full article is available here.

Looks like we should drop the height-based eligibility criteria on both MAM and SAM treatment programs.

Anonymous 3213

Normal user

13 Dec 2018, 15:26

Thank you Mark for sharing the articles.

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