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Community and International Nutrition

Malnourished Children Treated in Day-Hospital or Outpatient Clinics Exhibit Linear Catch-Up and Normal Body Composition¹

Janaina das Neves^*, Paula A. Martins^*,2, Ricardo Sesso and Ana L. Sawaya^*

^* Department of Physiology, Discipline of Physiology of Nutrition, and Department of Medicine, Discipline of Nephrology, Federal University of São Paulo, São Paulo, Brazil

² To whom correspondence should be addressed. E-mail: paulamartins{at}ecb.epm.br.

The nutritional programming hypothesis proposes that early life malnutrition is related to an increase in body fat later in life. Brazilian boys and girls (n = 94; 4–14 y old) were studied. Malnourished children treated in a Nutrition Recovery Center, were followed up and divided into 2 groups: the Outpatient group (recovered after outpatient care, n = 28), and the Day-hospital group (recovered after day-hospital care, n = 38). They were compared with a Control group (healthy individuals without intervention, n = 28). Nutritional recovery was confirmed by anthropometry. Body composition was evaluated by dual-energy X-ray absorptiometry. Both recovered groups had a greater increase in height-for-age Z-scores than in weight-for-age Z-scores after treatment (P < 0.03). Body fat mass (kg) and the percentage of body fat were significantly lower in recovered groups of girls and boys compared with controls. Among boys, lean mass/height (kg/cm), fat-free mass (kg) and the fat-free mass index (kg/m²) were significantly lower in the Outpatient and Day-hospital groups than in Controls, but girls did not differ. Bone mineral content (BMC)/height (g/cm) did not differ between the recovered girls and the girls in the Control group (P < 0.15) or between the boys in the Day-hospital group and those in the Control group (P = 0.06). The Outpatient boys group had lower BMC/height than boys in the Control group (P = 0.02). This study demonstrates that when malnourished children receive adequate treatment, linear catch-up growth occurs and is followed by appropriate gain in lean body mass and BMC.

KEY WORDS: • nutritional recovery • body composition • DXA • food intake • Brazil