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            <title xml:lang="fr">Signification clinique du diagnostic anthropométrique de la malnutrition aiguë sévère (MAS) de l’enfant : résultats préliminaires de l’étude multicentrique OptiDiag et implications en terme de santé publique</title>
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                <forename type="first">Trenton</forename>
                <surname>Dailey-Chwalibóg</surname>
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            <funder>The data presented in this article are part of the OptiDiag study, which is funded by Action Contre la Faim France with financial support from the European Commission's Civil Protection and Humanitarian Aid Operations Enhanced Response Capacity (grant ECHO/ERC/BUD/2015/91002) and the Humanitarian Innovation Fund, a program managed by Enhanced Learning and Research for Humanitarian Assistance. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.</funder>
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                <title xml:lang="fr">Signification clinique du diagnostic anthropométrique de la malnutrition aiguë sévère (MAS) de l’enfant : résultats préliminaires de l’étude multicentrique OptiDiag et implications en terme de santé publique</title>
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              <p>Introduction et but de l’étudePour diagnostiquer la malnutrition aiguë sévère (MAS) chez l’enfant, l’OMS recommande d’utiliser deux critères anthropométriques indépendants : l’indice poids-taille (IPT &lt; −3 ET) et le périmètre brachial (PB &lt; 115 mm). Néanmoins, l’utilisation du PB comme seul indicateur est de plus en plus fréquente, car il est souvent plus facile à mesurer que l’IPT et que certaines déclarations controversées d’experts suggèrent que les enfants de faible PB seraient plus à risque et que l’utilisation de l’IPT dans le dépistage et la prise en charge de la MAS ne présenterait aucun avantage en terme détection du risque de morbi-mortalité. Afin d’explorer cette hypothèse, l’étude OptiDiag a cherché à décrire et comparer l’état nutritionnel et les risques de morbi-mortalité associés aux différentes définitions de cas de MAS.Matériel et méthodesL’étude a pris appui sur une étude longitudinale multicentrique (Bangladesh, Burkina Faso et Liberia) chez les enfants identifiés comme souffrant de MAS, sans complications médicales, sur la base d’un faible PB seulement (PB-seul, n = 164), d’un faible IPT seulement (IPT-seul, n = 138), ou des deux déficits anthropométriques concomitamment (PB&amp;IPT, n = 153). En plus des mesures anthropométriques de routine, nous avons mesuré une gamme d’indicateurs de l’état clinique et nutritionnel, dont la leptine sérique. En effet, l’hypoleptinémie a récemment été reconnue comme un facteur majeur de risque de mortalité à court-terme chez les enfants atteints de MAS.Résultats et analyse statistiqueÀ l’admission pour la réhabilitation nutritionnelle, la leptinémie (valeur moyenne [IC 95 %]) des enfants PB-seul (331 [159–560] pg/mL) était significativement (p &lt; 0,001) plus élevée que celle des enfants IPT-seul (216 [122–347] pg/mL) et que celle des enfants PB&amp;IPT (180 [88–347] pg/mL), avant et après ajustement pour l’âge et le sexe. Ces résultats sont en accord avec ceux obtenus pour une série d’autres indicateurs biochimiques et cliniques, tels que les carences en fer, les signes visibles d’émaciation, la déshydratation ainsi que les déclarations maternelles de pertes de poids et d’appétit et de dégradation de l’état de santé.ConclusionPlutôt que de limiter les critères d’admission à la mesure du PB seul, nos résultats confirment la nécessité de conserver l’IPT en tant que critère diagnostic indépendant de la MAS et de renforcer les systèmes de santé en conséquence, conformément aux dernières recommandations de l’OMS.</p>
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