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Thymus size and its correlates among children admitted with severe acute malnutrition: a cross-sectional study in
Nicolette Nabukeera-Barungi1,2, Betty Lanyero3,4, Benedikte Grenov3
1Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. nicolettebarungi@gmail.com.
Insights
Children with severe acute malnutrition (SAM) have smaller thymus size, indicating impaired immune function. Thymus size correlates with nutritional status and illness duration, highlighting the impact of nutrition and infection on child immunity.
Area of Science:
- Pediatric Nutrition
- Immunology
- Child Health
Background:
- Severe acute malnutrition (SAM) is a major cause of child mortality and morbidity in resource-limited settings.
- Children with SAM exhibit thymus atrophy, suggesting impaired immune function and increased susceptibility to severe infections.
- Understanding thymus size correlates in SAM is crucial for identifying children with severe immune impairment.
Purpose of the Study:
- To describe thymus size at admission among children hospitalized with SAM.
- To identify correlates of thymus size in children with SAM.
Main Methods:
- A cross-sectional study was conducted on children aged 6-59 months with complicated SAM.
- Thymus size was measured using ultrasound, with well-nourished children serving as a reference group.
- Linear regression analysis was used to determine thymus size correlates.
Main Results:
- Children with SAM had significantly smaller thymus size compared to healthy children.
- Thymus size positively correlated with breastfeeding, anthropometric measurements, and suspected tuberculosis.
- Thymus size negatively correlated with longer illness duration (> 2 weeks).
Conclusions:
- The thymus serves as a nutritional barometer, with size reflecting nutritional status and breastfeeding.
- Breastfeeding provides immune benefits for children with SAM.
- Infections, indicated by longer illness duration, contribute to thymus atrophy in SAM.
Background:
Malnutrition continues to be a major cause of mortality and morbidity among children in resource limited settings. Children with severe acute malnutrition (SAM) experience severe thymus atrophy, possibly reflecting poor immune function. This immune dysfunction is responsible for the severe infections they experience which lead to mortality. Since their immune dysfunction is not fully understood and there has been a lapse in research in this field, more research is needed. Knowing the correlates of thymus size may help clinicians identify those with more severe atrophy who might have more severe immune impairment. We aimed to describe thymus size and its correlates at admission among children hospitalized with SAM.
Methods:
This cross-sectional study involved children 6-59 months admitted with complicated SAM in Mulago National Referral Hospital. Well-nourished children from same communities were used as a community reference group for thymus size. At admission, thymus size was measured by ultrasound scan. Demographic, clinical and laboratory variables were identified at admission. A linear regression model was used to determine correlates of thymus size among children with SAM.
Results:
Among 388 children with SAM, the mean age was 17±8.5 months and 58% were boys. The mean thymus size was 3.14 (95% CI 2.9; 3.4) cm2 lower than that of the 27 healthy community reference children (1.06 vs 4.2 cm2, p<0.001) when controlled for age. Thymus size positively correlated with current breastfeeding (0.14, 95% CI 0.01, 0.26), anthropometric measurements at admission (weight, length, mid-upper-arm circumference, weight-for-height Z scores and length-for-age Z scores) and suspected tuberculosis (0.12, 95% CI 0.01; 0.22). Thymus size negatively correlated with > 2 weeks duration of sickness (-0.10; 95% CI -0.19; -0.01).
Conclusion:
The thymus is indeed a barometer for nutrition since all anthropometric measurements and breastfeeding were associated with bigger thymus. The immune benefits of breastfeeding among children with SAM is underscored. Children with longer duration of illness had a smaller thymus gland indicating that infections have a role in the cause or consequence of thymus atrophy.
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