Nutritional assessment: the problem of clinical-anthropometrical mismatch

Abstract

Objective: To study risk factors for and prevalence and validity of clinical-anthropometrical mismatch (CAM) defined as the presence of clinical signs of protein-energy malnutrition despite normal weight-for-age (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 nutritional staging, anthropometry, diagnosis of diarrhoea and severe respiratory 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 long-term mortality. Of all the children with clinical signs of malnutrition, a high proportion had normal WFA. CAM was associated with weight loss within the limits of the international reference.

Conclusions: If a child has a normal weight but clinical malnutrition signs are present, the clinical diagnosis should prevail. Weight charts are not fully appropriate for nutritional classification purposes. The clinical nutritional staging used in this study is sufficiently reproducible and capable of identifying children with functional malnutrition.