TY - JOUR
T1 - Optimal anthropometric discharge criteria from treatment of wasting: meta-analysis of individual patient data from 34 studies
AU - for members of the SAM/MAM Relapse Pooling Project
AU - Bliznashka, Lilia
AU - Chaudhary, Sandhya
AU - Rattigan, Susan M.
AU - Isanaka, Sheila
AU - Adah, Ruth
AU - Ahmed, Tahmeed
AU - Alam, Nur
AU - Alitanou, Rodrigue
AU - Bahwere, Paluku
AU - Bailey, Jeanette
AU - Barthorp, Harriet
AU - Becquet, Renaud
AU - Belchior-Bellino, Valérie
AU - Beri, Alemayehu
AU - Berthé, Fatou
AU - Bhandari, Nita
AU - Bose, Anuradha
AU - Burza, Sakib
AU - Casademont, Cristian
AU - Cazes, Cécile
AU - Chaturvedi, Anuraag
AU - Collins, Steve
AU - Coulibaly, Issa
AU - Cuneo, C. Nicholas
AU - Dansereau, Emily
AU - Daures, Maguy
AU - Diala, Udochukwu
AU - Djibo, Ali
AU - Escruela, Montserrat
AU - Faal, Abdoulie
AU - Griswold, Stacy
AU - Guesdon, Benjamin
AU - Guindo, Ousmane
AU - Hien, Jérémie
AU - Hossain, Md Iqbal
AU - Hug, Julia
AU - Iyengar, Sharad
AU - Jasper, Paul
AU - John, Collins
AU - Kangas, Suvi T.
AU - Kornetsky, Kenneth
AU - Lambebo, Abera
AU - Legese, Liya
AU - Lelijveld, Natasha
AU - Mahajan, Raman
AU - Manary, Mark
AU - Mohan, Sanjana
AU - Myatt, Mark
AU - Nabwera, Helen
AU - Nackers, Fabienne
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/12/1
Y1 - 2025/12/1
N2 - Background: Community-based treatment of acute malnutrition saves lives, but recovered children remain at risk of relapse postdischarge. Strategies to reduce this risk may include modification of anthropometric discharge criteria. Objectives: This study aims to compare the diagnostic accuracy of anthropometric indices to reduce postdischarge relapse risk. Methods: We searched PubMed from inception to June 2022. We included studies that enrolled children aged 0–59 mo successfully treated for severe or moderate acute malnutrition (SAM or MAM), assessed anthropometry at discharge, and had ≥1 follow-up assessment ≤6 mo postdischarge. Pooled sensitivity and specificity for anthropometric indices at discharge over multiple cutoffs were calculated using a bivariate mixed-effects model. Area under the pooled receiver operating curve (AUC) was estimated to measure diagnostic accuracy. “Pragmatic” cutoffs were defined as those maximizing AUC given both pooled sensitivity and pooled specificity ≥0.75. Primary outcomes were SAM relapse (SAM episode after successful SAM treatment: weight-for-height Z-score (WHZ) < −3, mid-upper arm circumference (MUAC) < 11.5 cm and/or edema) and MAM relapse (MAM episode after successful MAM treatment: −3 ≤ WHZ < −2 or 11.5 cm ≤ MUAC < 12.5 cm). Exposures were WHZ, MUAC, and weight-for-age Z-score (WAZ) at discharge. Results: We included 34 studies from 16 countries contributing 21,989 children. WHZ at discharge had a higher AUC in predicting lower SAM and MAM relapse risk than MUAC or WAZ at discharge. None of the cutoffs examined met the study definition of “pragmatic.” The closest “pragmatic” cutoffs suggested that WHZ cutoffs of −1.4 and −1.8 or MUAC of 12.6 and 12.7 cm had the highest sensitivity and specificity in predicting lower SAM and MAM relapse risk. Conclusions: Relapse risk is high after successful MAM/SAM treatment. Future research can consider optimization of anthropometric discharge criteria as a strategy to reduce postdischarge relapse risk, weighing the operational and financial tradeoffs associated with any modification. This trial was registered at PROSPERO as CRD42022342009.
AB - Background: Community-based treatment of acute malnutrition saves lives, but recovered children remain at risk of relapse postdischarge. Strategies to reduce this risk may include modification of anthropometric discharge criteria. Objectives: This study aims to compare the diagnostic accuracy of anthropometric indices to reduce postdischarge relapse risk. Methods: We searched PubMed from inception to June 2022. We included studies that enrolled children aged 0–59 mo successfully treated for severe or moderate acute malnutrition (SAM or MAM), assessed anthropometry at discharge, and had ≥1 follow-up assessment ≤6 mo postdischarge. Pooled sensitivity and specificity for anthropometric indices at discharge over multiple cutoffs were calculated using a bivariate mixed-effects model. Area under the pooled receiver operating curve (AUC) was estimated to measure diagnostic accuracy. “Pragmatic” cutoffs were defined as those maximizing AUC given both pooled sensitivity and pooled specificity ≥0.75. Primary outcomes were SAM relapse (SAM episode after successful SAM treatment: weight-for-height Z-score (WHZ) < −3, mid-upper arm circumference (MUAC) < 11.5 cm and/or edema) and MAM relapse (MAM episode after successful MAM treatment: −3 ≤ WHZ < −2 or 11.5 cm ≤ MUAC < 12.5 cm). Exposures were WHZ, MUAC, and weight-for-age Z-score (WAZ) at discharge. Results: We included 34 studies from 16 countries contributing 21,989 children. WHZ at discharge had a higher AUC in predicting lower SAM and MAM relapse risk than MUAC or WAZ at discharge. None of the cutoffs examined met the study definition of “pragmatic.” The closest “pragmatic” cutoffs suggested that WHZ cutoffs of −1.4 and −1.8 or MUAC of 12.6 and 12.7 cm had the highest sensitivity and specificity in predicting lower SAM and MAM relapse risk. Conclusions: Relapse risk is high after successful MAM/SAM treatment. Future research can consider optimization of anthropometric discharge criteria as a strategy to reduce postdischarge relapse risk, weighing the operational and financial tradeoffs associated with any modification. This trial was registered at PROSPERO as CRD42022342009.
KW - acute malnutrition
KW - anthropometry
KW - discharge
KW - relapse
KW - wasting
U2 - 10.1016/j.ajcnut.2025.09.010
DO - 10.1016/j.ajcnut.2025.09.010
M3 - Article
AN - SCOPUS:105022759037
SN - 0002-9165
VL - 122
SP - 1658
EP - 1668
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
IS - 6
ER -
SDG 2 Zero Hunger