Association between anthropometric criteria and body composition among children aged 6–59 months with uncomplicated severe acute malnutrition: A prospective cohort study from South Sudan
- 1Medair Global Support Office, Ecublens, Switzerland
- 2Medair South Sudan Country Program, Juba, South Sudan
- 3Department of Statistics, Seoul National University, Seoul, Korea
Abstract
Background: Severe acute malnutrition (SAM) is diagnosed based on bilateral edema, mid‑upper arm circumference (MUAC), and/or weight‑for‑height z‑score (WHZ). These criteria do not fully overlap and may identify children with distinct biological and clinical profiles. Understanding how children with SAM identified by different criteria differ in body composition during outpatient therapeutic program (OTP) treatment may help inform treatment and post‑discharge practices. Methods: We conducted a prospective cohort study of children aged 6–59 months with uncomplicated SAM admitted by MUAC only (MUAC group), WHZ only (WHZ group), or combined MUAC and WHZ criteria (Combined group) in Aweil Centre, South Sudan. Anthropometry, triceps skinfold thickness, and bioelectrical impedance analysis were collected at admission (n = 194) and discharge (n = 127). Fat mass (FM), fat‑free mass (FFM), fat mass index (FMI), fat‑free mass index (FFMI), total body water percentage (TBW), and phase angle (PhA) were assessed. Between‑group differences and within‑child changes were analyzed using linear mixed effects models adjusted for age and sex. Results: At admission, children in the MUAC and Combined groups were younger and more stunted, with the Combined group showing the most severe deficits across anthropometry, FMI, and PhA. During treatment, the WHZ group exhibited the fastest recovery, with predominantly FFM accretion (82% of weight gain) and the largest increases in FFMI. In contrast, the MUAC group accumulated mainly FM (78% of weight gain) with minimal FFM gain and a decline in PhA, while the Combined group showed mixed FM and FFM recovery patterns. Conclusions: Children admitted for outpatient SAM treatment by MUAC, WHZ, or combined criteria appeared to follow different recovery trajectories despite meeting standard anthropometric discharge thresholds. Body‑composition and impedance indicators suggested heterogeneity in tissue gain patterns and vulnerability profiles across admission groups, particularly in the MUAC and Combined groups. While exploratory, these findings suggest that anthropometric recovery alone may not uniformly capture the full recovery pattern across SAM admission groups, warranting the need for longitudinal studies evaluating whether body-composition differences at discharge predict subsequent clinical outcomes and post-discharge vulnerability.
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BibTeX
@article{rossi2026association,
title = {{Association between anthropometric criteria and body composition among children aged 6–59 months with uncomplicated severe acute malnutrition: A prospective cohort study from South Sudan}},
author = {Gabriele Rossi and Rachel M. Creighton and Patricia Ayebazibwe and Santo Garang and Mohammed Kamruzzaman and Taesung Park and Namseon Beck and Wendy Dyment},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0356530},
url = {https://doi.org/10.1371/journal.pone.0356530},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between anthropometric criteria and body composition among children aged 6–59 months with uncomplicated severe acute malnutrition: A prospective cohort study from South Sudan
AU - Gabriele Rossi
AU - Rachel M. Creighton
AU - Patricia Ayebazibwe
AU - Santo Garang
AU - Mohammed Kamruzzaman
AU - Taesung Park
AU - Namseon Beck
AU - Wendy Dyment
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0356530
UR - https://doi.org/10.1371/journal.pone.0356530
AB - Background: Severe acute malnutrition (SAM) is diagnosed based on bilateral edema, mid‑upper arm circumference (MUAC), and/or weight‑for‑height z‑score (WHZ). These criteria do not fully overlap and may identify children with distinct biological and clinical profiles. Understanding how children with SAM identified by different criteria differ in body composition during outpatient therapeutic program (OTP) treatment may help inform treatment and post‑discharge practices. Methods: We conducted a prospective cohort study of children aged 6–59 months with uncomplicated SAM admitted by MUAC only (MUAC group), WHZ only (WHZ group), or combined MUAC and WHZ criteria (Combined group) in Aweil Centre, South Sudan. Anthropometry, triceps skinfold thickness, and bioelectrical impedance analysis were collected at admission (n = 194) and discharge (n = 127). Fat mass (FM), fat‑free mass (FFM), fat mass index (FMI), fat‑free mass index (FFMI), total body water percentage (TBW), and phase angle (PhA) were assessed. Between‑group differences and within‑child changes were analyzed using linear mixed effects models adjusted for age and sex. Results: At admission, children in the MUAC and Combined groups were younger and more stunted, with the Combined group showing the most severe deficits across anthropometry, FMI, and PhA. During treatment, the WHZ group exhibited the fastest recovery, with predominantly FFM accretion (82% of weight gain) and the largest increases in FFMI. In contrast, the MUAC group accumulated mainly FM (78% of weight gain) with minimal FFM gain and a decline in PhA, while the Combined group showed mixed FM and FFM recovery patterns. Conclusions: Children admitted for outpatient SAM treatment by MUAC, WHZ, or combined criteria appeared to follow different recovery trajectories despite meeting standard anthropometric discharge thresholds. Body‑composition and impedance indicators suggested heterogeneity in tissue gain patterns and vulnerability profiles across admission groups, particularly in the MUAC and Combined groups. While exploratory, these findings suggest that anthropometric recovery alone may not uniformly capture the full recovery pattern across SAM admission groups, warranting the need for longitudinal studies evaluating whether body-composition differences at discharge predict subsequent clinical outcomes and post-discharge vulnerability.
SN - 1932-6203
ER -