Associations of early childhood exposure to severe acute malnutrition and recovery with cardiometabolic risk markers in later childhood: 5-year prospective matched cohort study in Ethiopia

Background: Impaired fetal and accelerated postnatal growth are associated with cardiometabolic disease. Few studies investigated how recovery from severe acute malnutrition (SAM) is associated with childhood cardiometabolic risk.

Objective: We evaluated cardiometabolic risk in SAM children treated through community-based management, relative to controls, 5-year post-recovery. Recognizing the heterogeneity of SAM case definitions and patterns of nutritional recovery, we also identified distinct BMI-for-age (BAZ) trajectories of SAM children in the first-year post-recovery and examined their associations with anthropometry, body composition and cardiometabolic risk markers 5-years later.

Design: A prospective cohort study in 2013 enrolled children aged 6-59 months, recovered from SAM (n=203), or non-wasted controls (n=202), in Jimma Zone, Ethiopia. Anthropometry, body composition and cardiometabolic markers were assessed 5-year post-recovery. Multiple linear regression models compared outcomes between SAM-recovered children and controls. We used latent class trajectory modelling to identify BAZ trajectories in the first-year post-recovery and compared these trajectory groups with controls.

Result: We traced 291 (71.9%) children (mean age 6.2 years) at 5-year follow-up. Overall, compared to controls, SAM-recovered children did not differ in cardiometabolic risk. We identified 4 BAZ trajectories among SAM-recovered children: "Increase" (74.6%), "Decrease" (11.0%), "Decrease-increase" (5.0%), and "Increase-decrease" (9.4%). Compared to controls, all BAZ trajectories except "Decrease-increase" had lower weight, height and fat-free mass index. Compared to controls, the "Decrease-increase" trajectory had lower glucose (-15.8 mg/dL; 95%CI: -31.2, -0.4), while the "Increase-decrease" trajectory had higher glucose (8.1 mg/dL; CI: -0.8, 16.9). Compared to controls, the "Decrease-increase" and "Decrease" trajectories had higher total-cholesterol (24.3 mg/dL; CI: -9.4, 58.4) and LDL-cholesterol (10.4 mg/dL; CI: -3.8, 24.7), respectively. The "Increase" trajectory had lowest cardiometabolic risk.

Conclusion: Both rapid BAZ increase and decrease during early post-recovery from SAM were associated with greater cardiometabolic risk 5-years later. The findings indicate the need to target post-recovery interventions to optimize healthy weight recovery.