J. Vandenbroeck et al., NUTRITIONAL ASSESSMENT - THE PROBLEM OF CLINICAL ANTHROPOMETRICAL MISMATCH, European journal of clinical nutrition, 48(1), 1994, pp. 60-65
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.