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

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, relative to controls, 5-y postrecovery.

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.