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

Abstract

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.

Malnutrition in Infants Aged under 6 Months Attending Community Health Centres: A Cross Sectional Survey

“…However, less attention has been given to assess how well it predicts a longer-term risk of impaired physical or cognitive development. Evidence from a recent systematic review shows that adverse nutrition in infancy and childhood is associated with long-term adult non-communicable disease [ 6 ]. Future research should explore how both MUAC and the various subcategories of CIAF predict these longer-term risks and possible underlying mechanisms and pathways.…”

“…In addition, an estimated 20.5 million livebirths have a LBW [ 4 ]. These first six months of life are recognised as a crucial developmental period, often with unique nutritional challenges, but with life-long adverse consequences if malnutrition develops [ 5 , 6 ].…”

Malnutrition in Infants Aged under 6 Months Attending Community Health Centres: A Cross Sectional Survey

“…However, less attention has been given to assess how well it predicts a longer-term risk of impaired physical or cognitive development. Evidence from a recent systematic review shows that adverse nutrition in infancy and childhood is associated with long-term adult non-communicable disease [6]. Future research should explore how both MUAC and the various subcategories of CIAF predict these longer-term risk and possible underlying mechanisms and pathways.…”

“…These deficits are associated with increased risk of mortality, morbidity, subsequent malnutrition, and impaired a LBW [4]. These first six months of life are recognised as a crucial developmental period, often with unique nutritional challenges, but with life-long adverse consequences if malnutrition develops [5,6].…”

Childhood Malnutrition and Association of Lean Mass with Metabolome and Hormone Profile in Later Life

“…We have previously shown that survivors of SM have deficient growth, including reduced lean mass compared to children with no history of SM [4]. Recent reports suggest that early postnatal growth failure and SM are associated with a higher risk of developing non-communicable diseases (NCD) during adulthood [5][6][7]. This increased risk is compounded by changing global dietary habits, which are characterized by higher caloric consumption, leading to a double burden of malnutrition [8].…”