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Gut function among children treated for severe acute malnutrition: A cohort study in Uganda
Betty Lanyero1,2, Nicolette Nabukeera-Barungi3, Ezekiel Mupere3
1Department of Paediatrics, Mwanamugimu Nutrition Unit Mulago National Referral Hospital Kampala Uganda.
Insights
Nutritional rehabilitation improved gut function in children with severe acute malnutrition (SAM). However, intestinal inflammation markers persisted after 8 weeks of outpatient care, indicating ongoing gut health challenges in recovering children.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
- Biomarker Research
Background:
- Severe acute malnutrition (SAM) in children is linked to impaired gut function and increased morbidity.
- Understanding gut health recovery during nutritional rehabilitation is crucial for improving outcomes in SAM patients.
Purpose of the Study:
- To evaluate changes in gut function biomarkers during nutritional rehabilitation for complicated severe acute malnutrition (SAM).
- To identify predictors of these gut function biomarker changes in SAM-affected children.
Main Methods:
- A cohort of 108 children (6-59 months) with complicated SAM were monitored during inpatient and outpatient therapeutic care.
- Key gut function biomarkers, including plasma citrulline and fecal markers of inflammation, were assessed at multiple time points.
- Biomarker levels were compared to healthy community reference children post-treatment.
Main Results:
- Plasma citrulline levels significantly increased during inpatient care, approaching normal values.
- Fecal markers indicated a decrease in myeloperoxidase but an increase in neopterin during inpatient treatment, with levels exceeding normal cut-offs.
- No significant differences in biomarkers were found between SAM children and controls after 8 weeks of outpatient care; probiotics showed no impact.
Conclusions:
- Inpatient nutritional rehabilitation can improve gut function in children with complicated SAM.
- Intestinal inflammation appears to be a persistent issue, remaining elevated even after 8 weeks of outpatient therapeutic care.
- Further interventions may be needed to fully resolve intestinal inflammation in children recovering from SAM.
Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
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.