NUTRITIONAL ASSESSMENT - THE PROBLEM OF CLINICAL ANTHROPOMETRICAL MISMATCH

Objective: To study risk factors for and prevalence and validity of cl inical-anthropometrical mismatch (CAM) defined as the presence of clin ical signs of protein-energy malnutrition despite normal weight-for-ag e (WFA). Design: A semi-longitudinal study of nutrition and morbidity with a longitudinal assessment of mortality. Setting: The rural health zone of Bwamanda in Northern Zaire. Subjects: 4238 children of age 0- 6 years enrolled by random cluster sampling. Intervention: Clinical nu tritional staging, anthropometry, diagnosis of diarrhoea and severe re spiratory infection in the rainy (first survey) and the subsequent dry season (second survey). Recording of mortality during 27 months after the second survey. Results: Prevalence of CAM was high above various cut-off levels of WFA and was accompanied by increased morbidity and l ong-term mortality. Of all the children with clinical signs of malnutr ition, a high proportion had normal WFA. CAM was associated with weigh t loss within the limits of the international reference. Conclusions: If a child has a normal weight but clinical malnutrition signs are pre sent, the clinical diagnosis should prevail. Weight charts are not ful ly appropriate for nutritional classification purposes. The clinical n utritional staging used in this study is sufficiently reproducible and capable of identifying children with functional malnutrition. Sponsor ship: This research was supported by the Nutricia Research Foundation. Descriptors: Marasmus, nutritional status, anthropometry, nutritional classification, clinical diagnosis.