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Catch Up Growth in SAM - what process?

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 2 replies.

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Cécile Salpéteur

Nutrition & Health Research Advisor - ACF France

Normal user

18 Aug 2011, 10:35

Is it correct to consider that catch up growth in a SAM child (marasmus) is very high then slows down as the child recuperates? Hence is it correct to consider that nutritional requirements for a SAM child progressively diminish once the child recuperates from SAM to MAM and back to "normal"? Globally I would be interested in any information describing the catch up growth of SAM children ! Thanks a lot

Mark Myatt

Epidemiologist at Brixton Health

Frequent user

18 Aug 2011, 12:48

Just to clarify ... what do you mean by "catch-up growth"? I have data on response to treatment for weight and MUAC. Response (in responders) tends to follows a typical growth curve with a rapid response followed by slower consolidation. This is the sort of curve we see in other fields (e.g. return of foveal sensitivity after retinal re-attachment surgery). I see this in both weight and MUAC. Is this what you mean?

Michael Golden

Normal user

18 Aug 2011, 13:27

Yes, this is correct. It is due to the different composition of the tissue that is laid down during catch-up (measured by impedence) - at first there is mainly lean tissue, which contains a higher water content during active protein synthesis - as the weight approaches normality the lean tissue is less hydrated and more fat is laid down. This process continues right up to around median weght-for-height where the exponential fall in rate of weight gain reaches an asymptote. You will not see this in many children as they are usually discharged at -1.5Z and so the final portion of the curve will not be observed. There is no change in the ratio of essential nutrients required during catch up - but there is a progressive reduction in the essential-nutrient to energy (nutrient density) needed. F100/RUTF is formulated to provide the required nutrients for rapid catch up with appropriate lean/fat tissue synthesis throughout recovery If CSB/family plate etc is given along with F100.RITF it slows the rate of catch up and there is a change in the ratio of lean/fat laid down so that insufficient functional tissue is made and although the children gain weight (less efficiently) they do not return physiologically or immunologically to normal.

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