Chronic disease outcomes after severe acute malnutrition in Malawian children (ChroSAM): a cohort study

Lelijveld, Natasha; Seal, Andrew; Wells, Jonathan C. K.; Kirkby, Jane; Opondo, Charles; Chimwezi, Emmanuel; Bunn, James; Bandsma, Robert; Heyderman, Robert S.; Nyirenda, Moffat; Kerac, Marko

doi:10.1016/s2214-109x(16)30133-4

Cited by 172 publications

(230 citation statements)

References 39 publications

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“…Severe wasting increases the incidence and severity of common childhood illnesses like diarrhoea and pneumonia (Chisti et al, ; Jones & Berkley, ; Talbert et al, ). Severe wasting in children aged less than 6 months of postnatal life may also affect long‐term developmental outcomes (Lelijveld et al, ).…”

Section: Introductionmentioning

confidence: 99%

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Choudhary

Srivastava

Chowdhury

et al. 2019

Maternal & Child Nutrition

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Burden and risk factors for wasting in the first 6 months of life among Indian children are not well documented. We used data from India's National Family Health Survey 4 to estimate the prevalence of severe wasting (weight for length < ‐3 SD) among 18,898 infants under 6 months of age. We also examined the association of severe wasting with household, maternal, and child‐related factors using multivariable logistic regression analysis. Prevalence of severe wasting among infants less than 6 months of age was 14.8%, ranging from 3.5 to 21% across states. Low birth weight (<2,500 g; adjusted odds ratio [AOR] 1.40, 95% CI [1.19, 1.65]), nonutilization of supplementary nutrition by mother during lactation (AOR 1.23, 95% CI [1.05, 1.43]), and anthropometric assessment during summer (AOR 1.37, 95% CI [1.13, 1.65]) and monsoon months (AOR 1.53, 95% CI [1.20, 1.95]) were associated with higher odds of severe wasting. Infants aged 2 to 3 months (AOR 0.78, 95% CI [0.66, 0.93]) and 4 to 5 months (AOR 0.65, 95% CI [0.55, 0.73]) had lower odds of severe wasting as compared with the 0‐ to 1‐month category. This analysis reveals a high burden of severe wasting in infants less than 6 months in India. Preventive interventions must be targeted at reducing low birth weight due to fatal growth restriction and prematurity. Appropriate care practices at facilities and postdischarge with extra attention to those born small and sick can prevent further deterioration in nutritional status.

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Section: Introductionmentioning

confidence: 99%

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Choudhary

Srivastava

Chowdhury

et al. 2019

Maternal & Child Nutrition

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“…Postdischarge mortality is also significant, with studies reporting mortality rates of 8.7% within 3 mo of discharge (3), or ≤18% of all treated cases dying within 1 y of discharge (4). Furthermore, even if the children survive, they suffer from long-term adverse effects, showing patterns of thrifty growth and functional deficits such as weak hand grip and impaired cardiovascular capacity (5). Children with SAM also show impaired cognitive function and substantial attention deficits (6, 7).…”

Section: Introductionmentioning

confidence: 99%

Metabolomic Changes in Serum of Children with Different Clinical Diagnoses of Malnutrition

Giovanni¹,

Bourdon²,

Wang³

et al. 2016

The Journal of Nutrition

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Background: Mortality in children with severe acute malnutrition (SAM) remains high despite standardized rehabilitation protocols. Two forms of SAM are classically distinguished: kwashiorkor and marasmus. Children with kwashiorkor have nutritional edema and metabolic disturbances, including hypoalbuminemia and hepatic steatosis, whereas marasmus is characterized by severe wasting. The metabolic changes underlying these phenotypes have been poorly characterized, and whether homeostasis is achieved during hospital stay is unclear.Objectives: We aimed to characterize metabolic differences between children with marasmus and kwashiorkor at hospital admission and after clinical stabilization and to compare them with stunted and nonstunted community controls.Methods: We studied children aged 9–59 mo from Malawi who were hospitalized with SAM (n = 40; 21 with kwashiorkor and 19 with marasmus) or living in the community (n = 157; 78 stunted and 79 nonstunted). Serum from patients with SAM was obtained at hospital admission and 3 d after nutritional stabilization and from community controls. With the use of targeted metabolomics, 141 metabolites, including amino acids, biogenic amines, acylcarnitines, sphingomyelins, and phosphatidylcholines, were measured.Results: At admission, most metabolites (128 of 141; 91%) were lower in children with kwashiorkor than in those with marasmus, with significant differences in several amino acids and biogenic amines, including those of the kynurenine-tryptophan pathway. Several phosphatidylcholines and some acylcarnitines also differed. Patients with SAM had profiles that were profoundly different from those of stunted and nonstunted controls, even after clinical stabilization. Amino acids and biogenic amines generally improved with nutritional rehabilitation, but most sphingomyelins and phosphatidylcholines did not.Conclusions: Children with kwashiorkor were metabolically distinct from those with marasmus, and were more prone to severe metabolic disruptions. Children with SAM showed metabolic profiles that were profoundly different from stunted and nonstunted controls, even after clinical stabilization. Therefore, metabolic recovery in children with SAM likely extends beyond discharge, which may explain the poor long-term outcomes in these children. This trial was registered at isrctn.org as ISRCTN13916953.

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“…Treatment guidelines have also changed since 1987, which means that the results of their study may need to be re‐evaluated. Although data on the mortality and relapse to SAM of children managed in Community‐Based Management of Acute Malnutrition programmes (uncomplicated SAM) have been reported (O'Sullivan, Lelijveld, Rutishauser‐Perera, Kerac, & James, ; Stobaugh et al, ), only a few papers reported nutritional outcomes of children after treatment from cSAM (Fergusson et al, ; Kerac et al, ; Kerac et al, ; Lelijveld et al, ).…”

Section: Discussionmentioning

confidence: 99%

Phenotype is sustained during hospital readmissions following treatment for complicated severe malnutrition among Kenyan children: A retrospective cohort study

Gonzales

Ngari

Njunge

et al. 2019

Maternal & Child Nutrition

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Hospital readmission is common among children with complicated severe acute malnutrition (cSAM) but not well‐characterised. Two distinct cSAM phenotypes, marasmus and kwashiorkor, exist, but their pathophysiology and whether the same phenotype persists at relapse are unclear. We aimed to test the association between cSAM phenotype at index admission and readmission following recovery. We performed secondary data analysis from a multicentre randomised trial in Kenya with 1‐year active follow‐up. The main outcome was cSAM phenotype upon hospital readmission. Among 1,704 HIV‐negative children with cSAM discharged in the trial, 177 children contributed a total of 246 readmissions with cSAM. cSAM readmission was associated with age<12 months (p = .005), but not site, sex, season, nor cSAM phenotype. Of these, 42 children contributed 44 readmissions with cSAM that occurred after a monthly visit when SAM was confirmed absent (cSAM relapse). cSAM phenotype was sustained during cSAM relapse. The adjusted odds ratio for presenting with kwashiorkor during readmission after kwashiorkor at index admission was 39.3 [95% confidence interval (95% CI) [2.69, 1,326]; p = .01); and for presenting with marasmus during readmission after kwashiorkor at index admission was 0.02 (95% CI [0.001, 0.037]; p = .01). To validate this finding, we examined readmissions to Kilifi County Hospital, Kenya occurring at least 2 months after an admission with cSAM. Among 2,412 children with cSAM discharged alive, there were 206 readmissions with cSAM. Their phenotype at readmission was significantly influenced by their phenotype at index admission (p < .001). This is the first report describing the phenotype and rate of cSAM recurrence.

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Chronic disease outcomes after severe acute malnutrition in Malawian children (ChroSAM): a cohort study

Cited by 172 publications

References 39 publications

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Metabolomic Changes in Serum of Children with Different Clinical Diagnoses of Malnutrition

Phenotype is sustained during hospital readmissions following treatment for complicated severe malnutrition among Kenyan children: A retrospective cohort study

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