Gizaw, Getu; Wells, Jonathan Ck; Argaw, Alemayehu; Olsen, Mette Frahm; Abdissa, Alemseged; Asres, Yaregal; Challa, Feyissa; ... Wibaek, Rasmus; + view all Gizaw, Getu; Wells, Jonathan Ck; Argaw, Alemayehu; Olsen, Mette Frahm; Abdissa, Alemseged; Asres, Yaregal; Challa, Feyissa; Berhane, Melkamu; Abera, Mubarek; Sadler, Kate; Boyd, Erin; Friis, Henrik; Girma, Tsinuel; Wibaek, Rasmus; - view fewer (2024) Associations of early childhood exposure to severe acute malnutrition and recovery with cardiometabolic risk markers in later childhood: 5-year prospective matched cohort study in Ethiopia. The American Journal of Clinical Nutrition 10.1016/j.ajcnut.2024.12.014. (In press).

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Abstract

BACKGROUND: Impaired fetal and accelerated postnatal growth are associated with cardiometabolic disease. Few studies investigated how recovery from severe acute malnutrition (SAM) is associated with childhood cardiometabolic risk. // OBJECTIVES: We evaluated cardiometabolic risk in children with SAM treated through community-based management, relative to controls, 5-y postrecovery. Recognizing the heterogeneity of SAM case definitions and patterns of nutritional recovery, we also identified distinct body mass index-for-age z-score (BAZ) trajectories of children with SAM in the first year postrecovery and examined their associations with anthropometry, body composition, and cardiometabolic risk markers 5 y later. // METHODS: A prospective cohort study in 2013 enrolled children aged 6-59 mo, recovered from SAM (n = 203), or nonwasted controls (n = 202), in Jimma Zone, Ethiopia. Anthropometry, body composition, and cardiometabolic markers were assessed 5 y postrecovery. Multiple linear regression models compared outcomes between SAM-recovered children and controls. We used latent class trajectory modeling to identify BAZ trajectories in the first year postrecovery and compared these trajectory groups with controls.// RESULTS: We traced 291 (71.9%) children (mean age 6.2 y) at 5-y follow-up. Overall, compared with controls, SAM-recovered children did not differ in cardiometabolic risk. We identified 4 BAZ trajectories among SAM-recovered children: "increase" (74.6%), "decrease" (11.0%), "decrease-increase" (5.0%), and "increase-decrease" (9.4%). Compared with controls, all BAZ trajectories except "decrease-increase" had lower weight, height, and fat-free mass index. Compared with controls, the "decrease-increase" trajectory had lower glucose [-15.8 mg/dL; 95% confidence interval (CI): -31.2, -0.4], whereas the "increase-decrease" trajectory had higher glucose (8.1 mg/dL; 95% CI: -0.8, 16.9). Compared with controls, the "decrease-increase" and "decrease" trajectories had higher total cholesterol (24.3 mg/dL; 95% CI: -9.4, 58.4) and low-density lipoprotein cholesterol (10.4 mg/dL; 95% CI: -3.8, 24.7), respectively. The "increase" trajectory had the lowest cardiometabolic risk. // CONCLUSIONS: Both rapid BAZ increase and decrease during early postrecovery from SAM were associated with greater cardiometabolic risk 5 y later. The findings indicate the need to target postrecovery interventions to optimize healthy weight recovery.

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