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Long-term effects of severe acute malnutrition on lung function in Malawian children: a cohort study
Natasha Lelijveld1,2,3, Marko Kerac2,3,4, Andrew Seal5
1Institute for Global Health, University College London, London, UK natasha.lelijveld.11@ucl.ac.uk.
Insights
Severe acute malnutrition (SAM) in early childhood did not impair lung function 7 years later. However, female sex and HIV positive status were linked to poorer lung function outcomes in children.
Area of Science:
- Pediatrics
- Pulmonology
- Nutritional Science
Background:
- Early life nutritional insults, such as severe acute malnutrition (SAM), are suspected to increase the risk of adult lung diseases.
- Understanding the long-term respiratory consequences of SAM is crucial for public health interventions.
Purpose of the Study:
- To evaluate the impact of SAM on spirometric lung function 7 years after treatment.
- To identify predictors of impaired lung function among SAM survivors.
Main Methods:
- Spirometry and pulse oximetry were performed on 237 Malawian children treated for SAM and compared with matched sibling and community controls.
- Lung function data were analyzed using z-scores based on Global Lung Function Initiative reference data.
Main Results:
- No significant differences in spirometric or oximetry outcomes were observed between SAM survivors and control groups.
- SAM survivors exhibited shorter leg length but similar sitting heights compared to controls, suggesting potential "lung-sparing" growth.
- Female sex and HIV-positive status were associated with poorer forced expiratory volume in 1 second (FEV1) z-scores.
Conclusions:
- Early childhood SAM was not associated with reduced lung function 7 years post-treatment when compared to local controls.
- Growth patterns in SAM survivors suggest adaptive "thrifty" or "lung-sparing" mechanisms.
- Female sex and HIV positivity are identified as risk factors for diminished lung function in this population.
Abstract:
Early nutritional insults may increase risk of adult lung disease. We aimed to quantify the impact of severe acute malnutrition (SAM) on spirometric outcomes 7 years post-treatment and explore predictors of impaired lung function.Spirometry and pulse oximetry were assessed in 237 Malawian children (median age: 9.3 years) who had been treated for SAM and compared with sibling and age/sex-matched community controls. Spirometry results were expressed as z-scores based on Global Lung Function Initiative reference data for the African-American population.Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were low in all groups (mean FEV1 z-score: -0.47 for cases, -0.48 for siblings, -0.34 for community controls; mean FVC z-score: -0.32, -0.38, and -0.15 respectively). There were no differences in spirometric or oximetry outcomes between SAM survivors and controls. Leg length was shorter in SAM survivors but inter-group sitting heights were similar. HIV positive status or female sex was associated with poorer FEV1, by 0.55 and 0.31 z-scores, respectively.SAM in early childhood was not associated with subsequent reduced lung function compared to local controls. Preservation of sitting height and compromised leg length suggest "thrifty" or "lung-sparing" growth. Female sex and HIV positive status were identified as potentially high-risk groups.