Diagnostic measures for Severe Acute Malnutrition in Indian
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Weight for length z-score (WLZ) less than -3 is currently used to define severe acute malnutrition (SAM) among infants. The objective of the current analysis was to compare WLZ with WAZ and length for age z-score (LAZ )in a cohort of Indian infants in predicting the deaths between 6 weeks and 6 months of age.

In this trial, infant's weight and length were measured at 6 weeks of age (at the time of the first immunization visit). Vital status of the infants was documented from 6 weeks to 6 months of age. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for WAZ less than -3, WLZ less than -3, and LAZ less than -3 for deaths between 6 weeks and 6 months of age. The receiver operating characteristics curve was calculated for each of the above anthropometric indicators.

Results:
--For deaths occurring between 6 weeks to 6 months of age, the specificity ranged between 85.9–95.9% for all three anthropometric indicators.

--However, the sensitivity was considerably higher for WAZ; it was 64.6% for WAZ less than -3, 39.1% for LAZ less than -3, and 25.0% for WLZ less than -3.

--WAZ less than -3 had higher area under curve and hence, better discriminated deaths between 6 weeks and 6 months of age than WLZ less than -3.

--The adjusted relative risk and the population attributable fraction of mortality was highest for WAZ less than -3.

WAZ less than -3 at 6 weeks of age was found to be a better indicator of death in the 6 weeks to 6 months of life than WLZ less than -3 and LAZ less than -3, and it was suggested that it should be used to diagnose SAM in this age group.

Source: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02629-9
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