Malnourished Children Treated in Day-Hospital or Outpatient Clinics Exhibit Linear Catch-Up and Normal Body Composition

Abstract

The nutritional programming hypothesis proposes that early life malnutrition is related to an increase in body fat later in life. Brazilian boys and girls (n = 94; 4-14 y old) were studied. Malnourished children treated in a Nutrition Recovery Center, were followed up and divided into 2 groups: the Outpatient group (recovered after outpatient care, n = 28), and the Day-hospital group (recovered after day-hospital care, n = 38). They were compared with a Control group (healthy individuals without intervention, n = 28). Nutritional recovery was confirmed by anthropometry. Body composition was evaluated by dual-energy X-ray absorptiometry. Both recovered groups had a greater increase in height-for-age Z-scores than in weight-for-age Z-scores after treatment (P < 0.03). Body fat mass (kg) and the percentage of body fat were significantly lower in recovered groups of girls and boys compared with controls. Among boys, lean mass/height (kg/cm), fat-free mass (kg) and the fat-free mass index (kg/m(2)) were significantly lower in the Outpatient and Day-hospital groups than in Controls, but girls did not differ. Bone mineral content (BMC)/height (g/cm) did not differ between the recovered girls and the girls in the Control group (P < 0.15) or between the boys in the Day-hospital group and those in the Control group (P = 0.06). The Outpatient boys group had lower BMC/height than boys in the Control group (P = 0.02). This study demonstrates that when malnourished children receive adequate treatment, linear catch-up growth occurs and is followed by appropriate gain in lean body mass and BMC.

Malnutrition, Long-Term Health and the Effect of Nutritional Recovery

“…Among the boys, body composition was normal, even though their values were lower in comparison to those of the control group. Similar findings have also been reported with respect to bone mineral density as outlined in figure 5 [10]. Recently, we studied how glucose metabolism and insulin levels changed in children who received adequate treatment at nutritional rehabilitation centers and showed linear catch-up growth.…”

“…According to data from the municipality of São Paulo, there are over 2,000 slums with the greatest concentration in the southern zone of the city (1,107) [9]. Data on malnourished children under treatment at a center for recovery from malnutrition in São Paulo (CREN) located in that zone [10] found that over 70% of the children were born with low or insufficient weight. CREN is a center that offers treatment to children from the slums who are reported to have mild to severe malnutrition.…”

“…Medians without a common letter differ: p < 0.05. Reprinted with permission from the Journal of Nutrition[10].…”

Long-Lasting Effects of Undernutrition

“…A study was performed with the objective of determining the body composition of previously malnourished children who adequately recovered in both height and weight after being treated at the CREN [107]. Children and adolescents, aged 4–14 y, were divided into 3 groups.…”

Estado nutricional de crianças e adolescentes hospitalizados em enfermaria de cirurgia pediátrica

“…A prevalência da desnutrição no Brasil em crianças hospitalizadas vem sendo estudada de forma isolada nos grandes hospitais, principalmente universitários, abrangendo populações com doenças variadas (3) . A obesidade, por sua vez, associa-se a várias doenças, constituindo fator de risco para hipertensão arterial, hipercolesterolemia, diabetes melito, doenças cardiovasculares, algumas formas de câncer e problemas respiratórios (4) .…”