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Linear and knemometric growth in the early phase of rehabilitation from severe malnutrition
C P Doherty1, M A Sarkar, M S Shakur
1Department of Child Health, University of Glasgow, Glasgow, UK. cd1c@clinmed.gla.ac.uk
Insights
Children recovering from severe malnutrition show early linear growth, with lower leg length reflecting ponderal status acutely. Catch-up growth in height (HAZ) linked to initial weight-for-height (WHZ) but linear growth occurred even with severe wasting.
Area of Science:
- Pediatrics
- Nutritional Science
- Human Growth and Development
Background:
- Severe malnutrition in children impairs growth, with unclear relationships between ponderal (weight-based) and linear (height-based) growth during recovery.
- Understanding early catch-up growth patterns is crucial for effective nutritional interventions in affected populations.
Purpose of the Study:
- To investigate the early growth dynamics of ponderal, linear, and lower leg dimensions in severely malnourished children.
- To determine the relationship between weight-for-height (WHZ) and height-for-age (HAZ) catch-up growth and lower leg length changes.
Main Methods:
- Longitudinal study of 141 severely malnourished Bangladeshi children (6-36 months) over 90 days.
- Regular measurements of weight, height, and lower leg length (using knemometry).
- Calculation of weight-for-height (WHZ) and height-for-age (HAZ) z-scores and analysis of growth rates.
Main Results:
- Significant catch-up growth in weight-for-height (WHZ z-score mean 1.6) and height-for-age (HAZ z-score mean 0.47).
- Mean lower leg length growth of 10.35 mm over 90 days.
- Linear growth (HAZ change) associated with initial WHZ, but occurred even with severe wasting; lower leg length gain correlated with ponderal indices throughout and HAZ after 45 days.
Conclusions:
- Linear growth is initiated early in severely malnourished children, even in the presence of wasting.
- Lower leg length measurement (knemometry) serves as an acute indicator of ponderal status in this population.
- Initial WHZ and maternal height were predictors of linear growth, explaining only 20% of variance, highlighting multifactorial influences.
Abstract:
The relationship between ponderal, linear and lower leg growth in children recovering from severe malnutrition remains unclear. We report on the early growth of 141 severely malnourished Bangladeshi children aged 6 to 36 months of age who were followed for 90 d. Mean (sd) weight for height (WHZ) and height for age (HAZ) catch-up growth z scores over the 90 d were 1.6 (0.85) and 0.47 (0.325) respectively. Mean (sd) lower leg length growth was 10.35 (4.5) mm. Change in HAZ was significantly associated with initial WHZ, but linear growth occurred in the presence of severe wasting and no threshold WHZ score was identified. Lower leg length gain correlated throughout with ponderal indices but with change in HAZ score only after day 45. Only initial WHZ score and maternal height predicted for linear growth and only accounted for 20 % of total variance. We conclude that linear growth occurs early in severely malnourished children but that knemometry behaves as a ponderal index acutely.
