Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
Am J Clin Nutr. 2021 Jul 1;114(1):70-79. doi: 10.1093/ajcn/nqab034.
Little is known about the long-term outcome of children treated for severe acute malnutrition (SAM) after nutritional rehabilitation.
To explore the association between SAM in childhood, noncommunicable diseases (NCDs), and low human capital in adulthood.
We identified 524 adults (median age: 22 y) who were treated for SAM during childhood in Eastern Democratic Republic of Congo between 1988 and 2007. They were compared with 407 community unexposed age- and sex-matched subjects with no history of SAM. The variables of interest were cardiometabolic risk markers for NCDs and human capital. For the comparison, we used linear and logistic regressions to estimate the association between SAM in childhood and the risk of NCDs and ordinal logistic regression for the human capital.
Compared with unexposed subjects, the exposed participants had a higher waist circumference [1.2 (0.02, 2.3) cm; P = 0.015], and a larger waist-to-height ratio [0.01 (0.01, 0.02) cm; P < 0.001]. On the other hand, they had a smaller hip circumference [-1.5 (-2.6, -0.5) cm; P = 0.021]. Regarding cardiometabolic markers for NCDs, apart from a higher glycated hemoglobin (HbA1c) [0.4 (0.2, 0.6); P < 0.001], no difference was observed in other cardiometabolic markers for NCD between the 2 groups. Compared with unexposed participants, exposed participants had a higher risk of metabolic syndrome (crude OR: 2.35; 95% CI: 1.22, 4.54; P = 0.010) and visceral obesity [adjusted OR: 1.44 (1.09, 1.89); P = 0.001]. The prevalence of hypertension, diabetes, overweight, and dyslipidaemia was similar in both groups. Last, the proportion of malnutrition survivors with higher socioeconomic status level was lower.
SAM during childhood was associated with a high risk of NCDs and lower human capital in adulthood. Thus, policymakers and funders seeking to fight the global spread of NCDs in adults in low-resource settings should consider the long-term benefit of reducing childhood SAM as a preventive measure to reduce the socioeconomic burden attributable to NCDs.
对于接受严重急性营养不良（SAM）治疗后康复的儿童的长期结局，人们知之甚少。
探讨儿童时期 SAM 与非传染性疾病（NCD）和成年后人力资本低下之间的关系。
我们在刚果民主共和国东部，于 1988 年至 2007 年期间，确定了 524 名患有 SAM 的成年患者（中位年龄：22 岁），并将其与 407 名无 SAM 史且年龄和性别匹配的社区未暴露人群进行了比较。感兴趣的变量包括 NCD 心血管代谢风险标志物和人力资本。为了进行比较，我们使用线性和逻辑回归来估计儿童时期 SAM 与 NCD 风险之间的关联，并使用有序逻辑回归来评估人力资本。
与未暴露组相比，暴露组的腰围更大[1.2（0.02，2.3）cm；P=0.015]，腰高比更高[0.01（0.01，0.02）cm；P<0.001]。另一方面，他们的臀围更小[-1.5（-2.6，-0.5）cm；P=0.021]。关于 NCD 的心血管代谢标志物，除了糖化血红蛋白（HbA1c）更高[0.4（0.2，0.6）；P<0.001]之外，两组之间的其他 NCD 心血管代谢标志物没有差异。与未暴露组相比，暴露组患代谢综合征的风险更高（未校正 OR：2.35；95%CI：1.22，4.54；P=0.010）和内脏肥胖[校正 OR：1.44（1.09，1.89）；P=0.001]。两组的高血压、糖尿病、超重和血脂异常的患病率相似。最后，营养状况较差的幸存者中具有较高社会经济地位水平的比例较低。
儿童时期 SAM 与成年后患 NCD 的风险增加和人力资本低下有关。因此，寻求在资源匮乏环境中降低成年 NCD 全球发病率的政策制定者和资金提供者，应考虑减少儿童 SAM 的长期益处，将其作为降低与 NCD 相关的社会经济负担的预防措施。
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