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Severe Malnutrition Assessment in Children in Rural Kenya
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To the Editor: In their study of assessment of severe malnutrition among hospitalized children in rural Kenya, Dr Berkley and colleagues1 found that malnourished children identified by mid upper arm circumference (MUAC) were more likely to have moderate anemia and kwashiorkor than were children identified by the weight-for-height z scores (WHZ) used by the World Health Organization (WHO).
The authors note that, unlike MUAC, WHZ is influenced by total body water and could be low due to acute dehydration. They did not discuss a possible converse misrepresentation of nutritional status by WHZ: among children with kwashiorkor, who have relatively high total body water as a result of low albumin levels, increased weight for height might identify greater rather than lesser degrees of malnutrition. Consistent with this in their study, WHZ identified fewer children with kwashiorkor than did MUAC, and more children with moderate anemia were identified by MUAC than by . . . [Full Text of this Article]
Christopher G. Hogness, MD, MPH
chogness@swmedctr.com
Department of Family Medicine
Southwest Washington Medical Center
Vancouver, Wash
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