Nutritional diagnosis in children.

Jornal de Pediatria. The aim of the study was to assess the nutritional status of children and adolescents with post-infectious bronchiolitis obliterans. The authors, however , seem to have misinterpreted the results concerning the diagnosis of " malnutrition. " An accurate assessment would demonstrate that the weight-forage (W/A) parameter should overestimate the prevalence of " malnutrition " as opposed to the results presented which underestimated the diagnosis of " malnutrition " when the weight-for-height (W/H) anthropo-metric relation was compared to the W/A parameter, since this index tends to consider all children to be the same height at a certain age. Thus, a child shorter than the average with adequate weight-for-height status would be misclassified as " malnourished " by the W/A index. This situation could be clearly observed in this study, which showed high prevalence of stunted children. The World Health Organization (WHO) 2 has recommended in a recent document that the W/A index should be used only in countries in which minimum stature, and therefore W/H, is a condition impossible to be achieved. The authors' technical position diverged when reporting that " the use of weight/age is very appropriate for tracking weight gain in children…, " when compared to the article on the new reference curves by the WHO, 2 which states the following: " Weight-forage is inadequate for monitoring growth beyond childhood due to its inability to distinguish between relative height and body mass... " Thus, the authors' statement that W/A is better than W/H came as a surprise to us, since it is based on a concept not validated by the WHO (pp. 162 and 163), 3 which-in the origin of the term to diagnose nutritional deficit-uses " wasting " for W/H and " underweight " for W/A, calling attention to a possible occurrence of stunting in the latter. The WHO also recommends not using the term malnutrition for deficits obtained exclusively by anthropometric parameters. The deficit in body nutritional reserve should be measured by W/H and, when detected, nutritional intervention would play a central role in reestablishing this deficit. The presence of short stature (H/A) may result from sequelae from previous impairments, such as birth length, in which a nutritional approach may result in little or no effect over this rees-tablishment. Therefore, W/H and H/A should be analyzed separately concerning the presence of nutritional deviations, differently from the analysis published by Waterlow, 4 whose classification is …