ORIGINAL ARTICLE   

Minerva Pediatrica 2020 February;72(1):14-21

DOI: 10.23736/S0026-4946.19.05417-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Early assessment of weight velocity can support frontline health workers in predicting malnutrition in HIV-exposed infants: preliminary results from a DREAM cohort in Malawi

Ersilia BUONOMO ¹ ✉, Paola GERMANO ², Stefania MORAMARCO ¹, Riccardo ROSSI ³, Andrea MALIZIA ¹, Paola SCARCELLA ¹, Stefano ORLANDO ¹, Gianni GUIDOTTI ⁴, Karin NIELSEN-SAINES ⁵, Dyna TEMBO ⁶, M. Cristina MARAZZI ⁷, Leonardo PALOMBI ¹

¹ Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; ² DREAM Program, Community of Sant’Egidio Catholic Association, Rome, Italy; ³ Department of Engineering, University of Rome Tor Vergata, Rome, Italy; ⁴ ASL Roma 1, Rome, Italy; ⁵ Department of Pediatrics, David Geffen UCLA School of Medicine, Los Angeles, CA, USA; ⁶ DREAM Program, Community of Sant’Egidio Catholic Association, Blantyre, Malawi; ⁷ Libera Università Maria SS. Assunta, Rome, Italy

BACKGROUND: Children born to HIV-positive mothers are particularly susceptible to malnutrition. Currently, monitoring programs rely on punctual anthropometric measurements to assess child growth. Growth velocities could be an additional tool in identifying critical time windows for prevention and implementation of early intervention for malnutrition.
METHODS: A retrospective analysis was conducted using data from 817 HIV exposed but uninfected children extracted from DREAM program database. By using the WHO reference for growth standards, patterns of weight velocity for different intervals of assessment from one to 18 months of age were explored. Odds ratios and multinomial logistic regressions between selected weight velocity Z-scores thresholds and successive malnutrition indices (at 6, 12, 18 months of age) were calculated.
RESULTS: Weight velocity was above the standard mean in the first 3 months, then progressively declined over time. In children with normal nutritional status, significant risks of becoming malnourished (mild malnutrition - underweight [OR 10.8; 95% CI: 4.5-26], chronic malnutrition - stunting [OR 8.3; 95% CI: 2-34.9] and acute malnutrition - wasting [OR 11.7; 95% CI: 1.5-90.5]) started when weight velocity Z-scores <0, at all interval ages. Multinomial regression showed that in the first 6 months, the weight velocity decrements strongly impacted on underweight (OR 17.9; 95% CI: 4-80.7), while the risk of Stunting occurred later at 18 months (OR 8.7; 95% CI: 4.3-17.6), with highest impact at the lowest thresholds.
CONCLUSIONS: The assessment of weight velocity Z-scores, coupled with the already validated malnutrition indices, can support frontline health workers in early prediction of child malnutrition and performing nutritional counselling in the context of HIV/AIDS and food insecurity.

KEY WORDS: Child nutrition disorders; HIV seropositivity; Child; Malawi