Post-malnutrition growth and its associations with child survival and non-communicable disease risk: a secondary analysis of the Malawi ‘ChroSAM’ cohort

Abstract

Objective: Explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition, and describe associations with survival and non-communicable disease (NCD) risk seven years post-treatment. Design: Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score (WAZ) and height-for-age z-score (HAZ). Three categorisation methods included: no categorisation, quintiles, and latent class analysis (LCA). Associations with mortality risk, and seven NCD indicators were analysed. Setting: Secondary data from Blantyre, Malawi between 2006 and 2014. Participants: A cohort of 1024 children treated for severe malnutrition (weight-for-length z-score <70% median and/or MUAC<110 mm and/or bilateral oedema) at aged 5 to 168 months Results: Faster weight gain during treatment (g/day) and after treatment (g/kg/day) were associated with lower risk of death (aOR 0.99, 95%CI 0.99 to 1.00; and aOR 0.91, 95% CI 0.87 to 0.94 respectively). In survivors (mean age 9 years), it was associated with greater hand grip strength (0.02, 95%CI 0.00 to 0.03) and larger HAZ (6.62, 95%CI 1.31 to 11.9), both indicators of better health. However, faster weight gain was also associated with increased waist:hip ratio (0.02, 95%CI 0.01 to 0.03), an indicator of later life NCD risk. The clearest patterns of association were seen when defining PMGr based on weight gain in g/day during treatment and using the LCA method to describe growth patterns. Weight deficit at admission was a major confounder. Conclusions: A complex pattern of benefits and risks is associated with faster PMGr. Both initial weight deficit and rate of weight gain have important implications for future health.

Faster rehabilitation weight gain during childhood is associated with risk of non-communicable disease in adult survivors of severe acute malnutrition

“…This is also one of very few studies to follow survivors of malnutrition for such a long period. Similar analysis of a Malawian cohort of children 7 years post-SAM also suggested possible NCD risk factors in those who had the fastest post-malnutrition weight gain [ 41 ] but whether this is maintained longer term remains to be seen. Whilst the consistency of association adds weight to this being a potentially causal relationship, work in other cohorts in other settings is needed.…”

A protocol for a proof-of-concept randomized control trial testing increased protein quantity and quality in ready-to-use therapeutic food in improving linear growth among 6-23-month-old children with severe wasting in Malawi

“…Another important consideration is that interventions like higher protein RUTF aim to promote rapid weight gain and, while this has been shown to be favourable for outcomes such as mortality, muscle strength and height gain; there is emerging evidence suggesting that rapid weight gain is also associated with a higher NCD risk later in life [ 72 ]. Thus, the balance of risk to benefits of these interventions must contextualize both short and longer-term outcomes.…”

The double burden of malnutrition in individuals: Identifying key challenges and re‐thinking research focus

“…There is an increased need for research focussing on identifying key biological derangements occurring during the critical first 1000 days of a child's life, along with key socio‐economic and environmental factors, within the same window, which can offer new insights into the gaps in the transition from undernutrition to obesity later in life. A comprehensive exploration of the diverse pathophysiological and phenotypic manifestations associated with type 2 diabetes, spanning both population‐level and individual‐level analyses has been widely endorsed (‘LSHTM Data Compass’; Lelijveld et al., 2023). This growing recognition emphasises the significance of understanding the inherent biological dysfunction in insulin secretion, paving the way for personalised prevention and treatment initiatives.…”