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Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia

Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia
Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia
HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score increase in impedance index and triceps skinfolds was associated with 48 % (adjusted hazard ratio 0·52, 95 % CI (0·30, 0·90)) and 17 % (adjusted hazard ratio 0·83, 95 % CI (0·71, 0·96)) lower hazard of death/readmission, respectively. HIV-positive v. HIV-negative children had lower gains in sum of skinfolds (mean difference -1·49, 95 % CI (-2·01, -0·97)) and impedance index Z-scores (-0·13, 95 % CI (-0·24, -0·01)) over 52 weeks. Children with non-oedematous v. oedematous SAM had lower mean changes in the sum of skinfolds (-1·47, 95 % CI (-1·97, -0·97)) and impedance index Z-scores (-0·23, 95 % CI (-0·36, -0·09)). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children.
fat mass, HIC, Hospitalisation, lean mass, severe acute malnutrition
0007-1145
1024-1033
Bwakura-Dangarembizi, Mutsa
261e58be-c94a-4a39-8c56-8b78612b71bf
Dumbura, Cherlynn
45052150-e488-48ce-8e06-2d407bcf1181
Ngosa, Deophine
b5e31e20-2701-4aa8-8921-30bed40da62e
Majo, Florence D.
1462dd8c-2c65-424a-a97a-d6d9a93ba541
Norris, Shane A.
1d346f1b-6d5f-4bca-ac87-7589851b75a4
al, et
df099e87-31d7-4ccf-a9fa-b92a380537f9
HOPE-SAM study team
Bwakura-Dangarembizi, Mutsa
261e58be-c94a-4a39-8c56-8b78612b71bf
Dumbura, Cherlynn
45052150-e488-48ce-8e06-2d407bcf1181
Ngosa, Deophine
b5e31e20-2701-4aa8-8921-30bed40da62e
Majo, Florence D.
1462dd8c-2c65-424a-a97a-d6d9a93ba541
Norris, Shane A.
1d346f1b-6d5f-4bca-ac87-7589851b75a4
al, et
df099e87-31d7-4ccf-a9fa-b92a380537f9

HOPE-SAM study team (2023) Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia. British Journal of Nutrition, 130 (6), 1024-1033. (doi:10.1017/S0007114522004056).

Record type: Article

Abstract

HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score increase in impedance index and triceps skinfolds was associated with 48 % (adjusted hazard ratio 0·52, 95 % CI (0·30, 0·90)) and 17 % (adjusted hazard ratio 0·83, 95 % CI (0·71, 0·96)) lower hazard of death/readmission, respectively. HIV-positive v. HIV-negative children had lower gains in sum of skinfolds (mean difference -1·49, 95 % CI (-2·01, -0·97)) and impedance index Z-scores (-0·13, 95 % CI (-0·24, -0·01)) over 52 weeks. Children with non-oedematous v. oedematous SAM had lower mean changes in the sum of skinfolds (-1·47, 95 % CI (-1·97, -0·97)) and impedance index Z-scores (-0·23, 95 % CI (-0·36, -0·09)). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children.

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Accepted/In Press date: 20 December 2022
e-pub ahead of print date: 27 December 2022
Published date: 28 September 2023
Keywords: fat mass, HIC, Hospitalisation, lean mass, severe acute malnutrition

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Local EPrints ID: 504088
URI: http://eprints.soton.ac.uk/id/eprint/504088
ISSN: 0007-1145
PURE UUID: 1c65b05c-7f71-4e91-bb83-97744642b2a7
ORCID for Shane A. Norris: ORCID iD orcid.org/0000-0001-7124-3788

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Date deposited: 22 Aug 2025 17:00
Last modified: 23 Aug 2025 02:16

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Contributors

Author: Mutsa Bwakura-Dangarembizi
Author: Cherlynn Dumbura
Author: Deophine Ngosa
Author: Florence D. Majo
Author: Shane A. Norris ORCID iD
Author: et al
Corporate Author: HOPE-SAM study team

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