Gut function among children treated for severe acute malnutrition: A cohort study in Uganda

Impaired gut function in children with severe acute malnutrition (SAM) is associated with morbidity. We aimed to assess changes in six biomarkers representing different domains of gut function among children with complicated SAM during nutritional rehabilitation, and to identify predictors of these changes.

We followed 108 children aged 6-59 months with complicated SAM who participated in a probiotic trial (ISRCTN16454889). Plasma citrulline, a marker of enterocyte mass, fecal myeloperoxidase and neopterin, markers of intestinal inflammation and other gut function biomarkers were assessed at admission, discharge from inpatient therapeutic care (ITC), and after 8 weeks of outpatient therapeutic care (OTC). We assessed changes in these biomarkers and compared OTC values with 30 healthy community reference children.

During ITC, plasma citrulline increased from very low to near normal values (geometric mean: 5.69-21.4 µmol/L, p < 0.001). The number of days with diarrhea predicted a higher increase in plasma citrulline (p = 0.020) during ITC, while children with human immunodeficiency virus and diarrhea on admission had a lower change in plasma citrulline in OTC. Fecal myeloperoxidase decreased (geometric mean: 16,546-3781 ng/mL, p < 0.001), while fecal neopterin increased (582-923 nmol/L, p < 0.01) during ITC; both were higher than normal level cut-offs of 2000 ng/mL and 70 nmol/L. During OTC, no biomarker differences were observed between children with SAM and community reference children. Probiotics did not influence the changes in any biomarker.

Inpatient treatment of children with complicated SAM may improve gut function; however, intestinal inflammation seems to persist even after 8 weeks in OTC. Trial Registration: www.isrctn.com: ISRCTN16454889.