Critical evaluation of the appetite test for children with severe acute malnutrition
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
Critical evaluation of the appetite test for children with severe acute malnutrition. / Zangenberg, Mike; Abdissa, Alemseged; Johansen, Øystein H.; Tesfaw, Getnet; Friis, Henrik; Briend, André; Eshetu, Beza; Kurtzhals, Jørgen A.L.; Girma, Tsinuel.
In: Tropical Medicine and International Health, Vol. 25, No. 4, 2020, p. 424-432.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Critical evaluation of the appetite test for children with severe acute malnutrition
AU - Zangenberg, Mike
AU - Abdissa, Alemseged
AU - Johansen, Øystein H.
AU - Tesfaw, Getnet
AU - Friis, Henrik
AU - Briend, André
AU - Eshetu, Beza
AU - Kurtzhals, Jørgen A.L.
AU - Girma, Tsinuel
N1 - CURIS 2020 NEXS 073
PY - 2020
Y1 - 2020
N2 - Objectives: The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome. Methods: We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models. Results: Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow-up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: −0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure. Conclusions: Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.
AB - Objectives: The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome. Methods: We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models. Results: Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow-up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: −0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure. Conclusions: Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.
KW - appetite
KW - community management
KW - risk assessment
KW - severe acute malnutrition
KW - therapeutic foods
U2 - 10.1111/tmi.13360
DO - 10.1111/tmi.13360
M3 - Journal article
C2 - 31828888
AN - SCOPUS:85078624809
VL - 25
SP - 424
EP - 432
JO - Tropical Medicine & International Health
JF - Tropical Medicine & International Health
SN - 1360-2276
IS - 4
ER -
ID: 235786180