Cardiometabolic Risk in Marasmus and Kwashiorkor Survivors

Boyne, Michael S.; Francis-Emmanuel, Patrice; Tennant, I; Thompson, Debbie; Forrester, Terrence

doi:10.1007/978-3-319-40007-5_58-1

Cited by 7 publications

(7 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results build on a narrative review of differences in cardiometabolic risk between marasmus and kwashiorkor survivors from Boyne et al (2017) by systematically identifying new evidence for an effect of severe malnutrition and famine exposure in childhood on NCD risk. 11 Building on the DOHaD hypothesis, these findings indicate that severe childhood malnutrition may not only have serious implications for short-term morbidity and mortality but also for survivors’ long-term health. This concept is described by Wells’ (2018) ‘capacity-load model of NCD risk’, which proposes that individuals develop physiological traits during early life that give them the capacity to maintain homeostasis in metabolism and cardiovascular function when challenged by a metabolic load.…”

Section: Discussionmentioning

confidence: 87%

“…Endocrine changes caused by malnutrition may influence body composition in adult survivors and affect their NCD risk. 11 Reduced growth factors (eg, IGF-1) and insulin, along with higher cortisol levels, may be conducive to stunting, reduced muscle mass, and a tendency towards obesity with high calorie intake. 76 In studies of older children who experienced severe malnutrition in early life, survivors had less lean mass and more stunting compared with community controls, which was associated with low IGF-1.…”

Section: Discussionmentioning

confidence: 99%

“…While a narrative review examining evidence of differences in cardiometabolic risk between marasmus and kwashiorkor survivors was conducted by Boyne et al in 2017, no systematic review examining evidence on NCD outcomes following severe malnutrition or famine exposure in childhood currently exists in the literature. 11 As more children survive severe malnutrition globally, greater knowledge in this area is key to informing improved policy and programming around severe childhood malnutrition that reduce NCD risk. This review brings together evidence from studies of survivors of documented severe childhood malnutrition in LMICs or famines to present a synthesis of current knowledge on this topic.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

et al. 2021

View full text Add to dashboard Cite

IntroductionChild malnutrition (undernutrition) and adult non-communicable diseases (NCDs) are major global public health problems. While convincing evidence links prenatal malnutrition with increased risk of NCDs, less is known about the long-term sequelae of malnutrition in childhood. We therefore examined evidence of associations between postnatal malnutrition, encompassing documented severe childhood malnutrition in low/middle-income countries (LMICs) or famine exposure, and later-life cardiometabolic NCDs.MethodsOur peer-reviewed search strategy focused on ‘severe childhood malnutrition’, ‘LMICs’, ‘famine’, and ‘cardiometabolic NCDs’ to identify studies in Medline, Embase, Global Health, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We synthesised results narratively and assessed study quality with the UK National Institute for Health and Care Excellence checklist.ResultsWe identified 57 studies of cardiometabolic NCD outcomes in survivors of documented severe childhood malnutrition in LMICs (n=14) and historical famines (n=43). Exposure to severe malnutrition or famine in childhood was consistently associated with increased risk of cardiovascular disease (7/8 studies), hypertension (8/11), impaired glucose metabolism (15/24) and metabolic syndrome (6/6) in later life. Evidence for effects on lipid metabolism (6/11 null, 5/11 mixed findings), obesity (3/13 null, 5/13 increased risk, 5/13 decreased risk) and other outcomes was less consistent. Sex-specific differences were observed in some cohorts, with women consistently at higher risk of glucose metabolism disorders and metabolic syndrome.ConclusionSevere malnutrition or famine during childhood is associated with increased risk of cardiometabolic NCDs, suggesting that developmental plasticity extends beyond prenatal life. Severe malnutrition in childhood thus has serious implications not only for acute morbidity and mortality but also for survivors’ long-term health. Heterogeneity across studies, confounding by prenatal malnutrition, and age effects in famine studies preclude firm conclusions on causality. Research to improve understanding of mechanisms linking postnatal malnutrition and NCDs is needed to inform policy and programming to improve the lifelong health of severe malnutrition survivors.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Collectively, the studies on the Jamaican survivors of acute childhood malnutrition support the hypothesis that the marasmic individuals had responded to intrauterine cues by predicting that they will live in a malnourished post-natal environment, and thus developed a metabolically thrifty phenotype. However, when exposed to the postnatal high nutrition levels now increasingly prevalent in Jamaica, these individuals are developing glucose intolerance at a relatively young adult age, which might be partially explained by epigenetic alterations [69]. By contrast, kwashiorkor children failed to predict a nutritionally deficient post-natal life and so developed with a more metabolically profligate metabolic phenotype; then, when faced with malnutrition, they were unable to adequately downregulate their metabolism and mobilize their nutritional stores, which increased their mortality risk.…”

Section: (C) Predictive Adaptive Responses In Humansmentioning

confidence: 99%

Evolutionary and developmental mismatches are consequences of adaptive developmental plasticity in humans and have implications for later disease risk

Gluckman

Hanson

Low

2019

Phil. Trans. R. Soc. B

103

View full text Add to dashboard Cite

A discrepancy between the phenotype of an individual and that which would confer optimal responses in terms of fitness in an environment is termed ‘mismatch’. Phenotype results from developmental plasticity, conditioned partly by evolutionary history of the species and partly by aspects of the developmental environment. We discuss two categories of such mismatch with reference primarily to nutrition and in the context of evolutionary medicine. The categories operate over very different timescales. A developmental mismatch occurs when the phenotype induced during development encounters a different environment post-development. This may be the result of wider environmental changes, such as nutritional transition between generations, or because maternal malnutrition or placental dysfunction give inaccurate information about the organism's likely future environment. An evolutionary mismatch occurs when there is an evolutionarily novel environment. Developmental plasticity may involve immediate adaptive responses (IARs) to preserve survival if an environmental challenge is severe, and/or predictive adaptive responses (PARs) if the challenge does not threaten survival, but there is a fitness advantage in developing a phenotype that will be better adapted later. PARs can have long-term adverse health consequences if there is a developmental mismatch. For contemporary humans, maternal constraint of fetal growth makes PARs likely even if there is no obvious IAR, and this, coupled with the pervasive nutritionally dense modern environment, can explain the widespread observations of developmental mismatch, particularly in populations undergoing nutritional transition. Both developmental and evolutionary mismatch have important public health consequences and implications for where policy interventions may be most effective. This article is part of the theme issue ‘Developing differences: early-life effects and evolutionary medicine'.

show abstract

“…For example, certain responses to early-life malnutrition (e.g. marasmus [33]) are likely to be the result of a prediction in utero of later-life nutritional environments, but will result in malprediction when individuals are faced with nutrition-rich diets later in life (often resulting in metabolic disorders [34]). They then discuss how evolutionary and developmental mismatches may differ in their mitigation.…”

Section: Overview Of the Issuementioning

confidence: 99%

Developing differences: early-life effects and evolutionary medicine

Kuijper

Hanson

Vitikainen

et al. 2019

Phil. Trans. R. Soc. B

View full text Add to dashboard Cite

Variation in early-life conditions can trigger developmental switches that lead to predictable individual differences in adult behaviour and physiology. Despite evidence for such early-life effects being widespread both in humans and throughout the animal kingdom, the evolutionary causes and consequences of this developmental plasticity remain unclear. The current issue aims to bring together studies of early-life effects from the fields of both evolutionary ecology and biomedicine to synthesise and advance current knowledge of how information is used during development, the mechanisms involved, and how early-life effects evolved. We hope this will stimulate further research into early-life effects, improving our understanding of why individuals differ and how this might influence their susceptibility to disease. This article is part of the theme issue ‘Developing differences: early-life effects and evolutionary medicine’.

show abstract

Cardiometabolic Risk in Marasmus and Kwashiorkor Survivors

Cited by 7 publications

References 67 publications

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

Evolutionary and developmental mismatches are consequences of adaptive developmental plasticity in humans and have implications for later disease risk

Developing differences: early-life effects and evolutionary medicine

Contact Info

Product

Resources

About