Beyond Z-scores: Measures to Advance Prevention and Treatment Outcomes in Child Malnutrition FAQR ICN Summary

There is a growing imperative to measure the nutrition and health impact of food-based humanitarian assistance with more precision to better inform policy and practice. For many decades, researchers and programmers have relied mainly on anthropometric Z-scores and related cutoffs to determine the nutritional status of children to assess the impact of interventions. However, Z-scores may fail to distinguish important physiological or cognitive factors which can bias the interpretation of health, malnutrition or recovery. A symposium was organized at the 2017 International Congress of Nutrition (ICN) in Buenos Aires, Argentina, to consider three measures which add important contextual information and have implications for how we approach the treatment and prevention of child malnutrition. This paper provides a summary of the Symposium and key messages on research priorities, policy implications and programming guidance.

Several experts were asked to offer their perspectives on each of the three measures considered. The first measure was body composition, i.e. the proportion of lean and fat mass, which can be more useful than weight or height in predicting certain health outcomes. The second measure was environmental enteric dysfunction (EED), whose presence has been shown to be a predictor of child undernutrition. The third measure was dietary protein quality combined with biomarker serum amino acids, which have been shown to be associated with child malnutrition. Current research is being conducted on the use and interpretation of these three measures in the context of malnutrition. However, similar challenges remain among all three. The technology required to evaluate these three measures remains costly and highly-trained technicians are needed. In addition, there is ongoing debate as to which evaluation methods are the most accurate and meaningful. Furthermore, while these measures are being explored, they are still not the main drivers in making decisions about a program’s effectiveness.

The Symposium discussed efforts to treat or prevent child malnutrition which need to move beyond measurement of Z-scores to determine treatment methods and understand the effects of food-based interventions. Further efforts are needed toward accessible technology, accepting the use of these new measures, and understanding how they should be interpreted. In the meantime, we should be taking what is already known about these three key areas into urgent consideration in research, policy and programming.