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Concept Development and Use of an Automated Food Intake and Eating Behavior Assessment Method
Published on: February 19, 2021
Critical evaluation of the appetite test for children with severe acute malnutrition
Mike Zangenberg1,2, Alemseged Abdissa3, Øystein H Johansen4,5
1Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
Insights
The appetite test for severe acute malnutrition (SAM) in children may not effectively identify those needing inpatient care. Medical complications appear to be a more relevant indicator of poor outcomes in SAM treatment.
Area of Science:
- Pediatrics
- Nutritional Science
- Global Health
Background:
- The appetite test is a recommended tool for risk stratifying children with severe acute malnutrition (SAM).
- Current guidelines suggest its use in both inpatient and outpatient settings despite limited supporting evidence.
- The test's efficacy in predicting poor treatment outcomes remains unevaluated.
Purpose of the Study:
- To evaluate the effectiveness of the appetite test in identifying children with SAM at risk of adverse treatment outcomes.
- To assess the correlation between appetite test results and treatment outcomes in children with SAM.
- To explore the role of medical complications as a risk indicator in SAM management.
Main Methods:
- An observational study was conducted with children diagnosed with SAM across three Ethiopian health facilities.
- The appetite test was administered independently, without influencing clinical management decisions.
- Data analysis involved mixed linear and logistic regression models to assess associations.
Main Results:
- Of 334 children enrolled, 298 underwent the appetite test, with 19% passing.
- Children failing the test showed significantly higher daily weight gain (6.6%) compared to those passing.
- Medical complications were present in 54% of children and were linked to metabolic disturbances, but neither the appetite test nor complications correlated with bacteraemia or treatment failure.
Conclusions:
- The findings challenge the utility of the appetite test for determining the need for inpatient care in SAM.
- Assessing medical complications alone may offer a more valuable risk stratification approach for SAM.
- Further evaluation of medical complications as a risk indicator in diverse settings is warranted.
Objectives:
The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome.
Methods:
We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models.
Results:
Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow-up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: -0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure.
Conclusions:
Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.
