{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:10:37Z","timestamp":1784038237704,"version":"3.55.0"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                  <jats:p>Use of mid\u2013upper arm circumference (MUAC) as a single screening tool for severe acute malnutrition (SAM) assumes that children with a low weight-for-height z score (WHZ) and normal MUAC have lower risks of morbidity and mortality. However, the pathophysiology and functional severity associated with different anthropometric phenotypes of SAM have never been well characterized. We compared clinical characteristics, biochemical features, and health and nutrition histories of nonedematous children with SAM who had (1) low WHZ only, (2) both low WHZ and low MUAC, or (3) low MUAC only.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>In Bangladesh, Burkina Faso, and Liberia, we conducted a multicentric cohort study in uncomplicated, nonedematous children with SAM and low MUAC only (n = 161), low WHZ only (n = 138), or a combination of low MUAC and low WHZ (n = 152). Alongside routine anthropometric measurements, we collected a wide range of critical indicators of clinical and nutritional status and viability; these included serum leptin, an adipocytokine negatively associated with mortality risk in SAM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Median leptin levels at diagnosis were lower in children with low WHZ only (215.8 pg\/mL; P &amp;lt; .001) and in those with combined WHZ and MUAC deficits (180.1 pg\/mL; P &amp;lt; .001) than in children with low MUAC only (331.50 pg\/mL). The same pattern emerged on a wide range of clinical indicators, including signs of severe wasting, dehydration, serum ferritin levels, and caretaker-reported health deterioration, and was replicated across study sites.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Illustrative of the likely heterogeneous functional severity of the different anthropometric phenotypes of SAM, our results confirm the need to retain low WHZ as an independent diagnostic criterion.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2020-027003","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T08:25:13Z","timestamp":1621585513000},"source":"Crossref","is-referenced-by-count":16,"title":["Clinical and Biochemical Markers of Risk in Uncomplicated Severe Acute Malnutrition"],"prefix":"10.1542","volume":"147","author":[{"given":"Trenton","family":"Dailey-Chwalib\u00f3g","sequence":"first","affiliation":[{"name":"Department of Expertise and Advocacy, Action Contre la Faim, Paris, France;"},{"name":"Universit\u00e9 Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 75005, Paris, France;"},{"name":"Department of Food Technology, Safety, and Health, Ghent University, Ghent, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Freemark","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, North Carolina;"},{"name":"Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Muehlbauer","sequence":"additional","affiliation":[{"name":"Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Roberfroid","sequence":"additional","affiliation":[{"name":"Department of Food Technology, Safety, and Health, Ghent University, Ghent, Belgium;"},{"name":"Belgian Health Care Knowledge Centre, Brussels, Belgium;"},{"name":"Medicine Department, Faculty of Medicine, University of Namur, Namur, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issa A.","family":"Kemokai","sequence":"additional","affiliation":[{"name":"Action Contre la Faim, Monrovia, Liberia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Rayhan","family":"Mostak","sequence":"additional","affiliation":[{"name":"Action Contre la Faim, Dhaka, Bangladesh;"},{"name":"Palli Karma-Sahayak Foundation, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Abdul","family":"Alim","sequence":"additional","affiliation":[{"name":"National Nutrition Service, Institute of Public Health Nutrition, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murad Md. Shamsher Tabris","family":"Khan","sequence":"additional","affiliation":[{"name":"National Nutrition Service, Institute of Public Health Nutrition, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Abul Hashem","family":"Khan","sequence":"additional","affiliation":[{"name":"Community Based Health Care, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Bawo","sequence":"additional","affiliation":[{"name":"Ministry of Health, Monrovia, Liberia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson K.","family":"Dunbar","sequence":"additional","affiliation":[{"name":"Ministry of Health, Monrovia, Liberia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis H.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"Fouillet","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 75005, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Francois","family":"Huneau","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 75005, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Kolsteren","sequence":"additional","affiliation":[{"name":"Department of Food Technology, Safety, and Health, Ghent University, Ghent, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Guesdon","sequence":"additional","affiliation":[{"name":"Department of Expertise and Advocacy, Action Contre la Faim, Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2021,6,1]]},"reference":[{"key":"2022010421234296400_B1","unstructured":"World Health Organization; United Nations Children\u2019s Fund. 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