Lelijveld, NJM;
(2016)
Long-term effects of severe acute malnutrition on growth, body composition, and function; a prospective cohort study in Malawi.
Doctoral thesis , UCL (University College London).
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Abstract
Background: Tackling severe acute malnutrition (SAM) is a global health priority. Whilst SAM-related mortality is well described, little is known about long-term effects on survivors. Given extensive evidence from developed countries that early nutritional insults have enduring detrimental effects, particularly heightened risk of non-communicable disease (NCD) in adulthood, it is plausible that SAM survivors could share some of these traits. Applying the DOHaD (Developmental Origins of Health and Disease) concept to a novel group, this study aimed to explore the long-term impacts of SAM on growth, body composition, and functional outcomes. Methods and Findings: From August 2013 to February 2014 I followed-up the 352/1024 Malawian children who were still alive following SAM treatment in 2006-2007, comparing them to siblings and age/sex matched community controls. Compared to community controls, SAMsurvivors had significantly lower height-for-age z-score (HAZ) (-0.4, CI -0.2 to -0.6) and limb length (-2.0cm, CI -1.0 to -3.0) although there was evidence of some catch-up growth. They also had smaller mid-upper arm, calf and hip circumferences and less lean mass. Functional deficits included: weaker hand-grip (-1.68kg, CI -0.9 to -2.4) and fewer minutes completed of an exercise test (-1.59 minutes, CI -1.0 to -2.5). There was no statistically significant impact on lung function, skinfold thickness, sitting height and head circumference. Conclusions: These results show that there are long-term implications of an episode of SAM in the areas of growth, body composition, and physical function. Most notable are deficits in HAZ, lean mass, grip strength, and preservation of sitting height and head circumference at the expense of leg length, a pattern consistent with ‘thrifty growth’ which is associated with increased future cardiometabolic disease risk. Some catch-up of linear growth has occurred, suggesting that interventions post-“first 1000 days” could still be effective. Children who experienced SAM at an older age had greater detrimental effects, emphasising the need for early intervention and better prevention. Further follow-up is required to establish the full impact of puberty, and societal transition such as greater access to high fat/sugar diets. Intervention studies are also needed to determine whether earlier SAM treatment, improved post-SAM care such as nutrition supplementation and/or physical fitness interventions, could minimise or reverse some of these long-term effects.
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