Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
Department of Pediatrics, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
J Trop Pediatr. 2021 Oct 6;67(5). doi: 10.1093/tropej/fmab091.
The frequency of recovery from undernutrition after an episode of severe malaria, and the relationship between undernutrition during severe malaria and clinical and cognitive outcomes are not well characterized.
We evaluated undernutrition and cognition in children in Kampala, Uganda 18 months to 5 years of age with cerebral malaria (CM), severe malarial anemia (SMA) or community children (CC). The Mullen Scales of Early Learning was used to measure cognition. Undernutrition, defined as 2 SDs below median for weight-for-age (underweight), height-for-age (stunting) or weight-for-height (wasting), was compared with mortality, hospital readmission and cognition over 24-month follow-up.
At enrollment, wasting was more common in CM (16.7%) or SMA (15.9%) than CC (4.7%) (both p < 0.0001), and being underweight was more common in SMA (27.0%) than CC (12.8%; p = 0.001), while prevalence of stunting was similar in all three groups. By 6-month follow-up, prevalence of wasting or being underweight did not differ significantly between children with severe malaria and CC. Undernutrition at enrollment was not associated with mortality or hospital readmission, but children who were underweight or stunted at baseline had lower cognitive z-scores than those who were not {underweight, mean difference [95% confidence interval (CI)] -0.98 (-1.66, -0.31), -0.72 (-1.16, -0.27) and -0.61 (-1.08, -0.13); and stunted, -0.70 (-1.25, -0.15), -0.73 (-1.16, -0.31) and -0.61 (-0.96, -0.27), for CM, SMA and CC, respectively}.
In children with severe malaria, wasting and being underweight return to population levels after treatment. However, being stunted or underweight at enrollment was associated with worse long-term cognition in both CC and children with severe malaria.
严重疟疾发作后恢复营养不足的频率，以及严重疟疾期间营养不足与临床和认知结局的关系尚未得到充分描述。
我们评估了乌干达坎帕拉患有脑疟疾（CM）、严重疟疾贫血（SMA）或社区儿童（CC）的 18 个月至 5 岁儿童的营养不足和认知情况。使用 Mullen 早期学习量表测量认知能力。将营养不足定义为体重与年龄的标准差低于中位数（体重不足）、身高与年龄的标准差低于中位数（发育迟缓）或体重与身高的标准差低于中位数（消瘦），并将其与 24 个月随访期间的死亡率、住院再入院和认知进行比较。
在入组时，CM（16.7%）或 SMA（15.9%）患儿的消瘦发生率高于 CC（4.7%）（均 p < 0.0001），SMA 患儿的体重不足发生率高于 CC（27.0%比 12.8%；p = 0.001），而三组患儿的发育迟缓发生率相似。在 6 个月随访时，严重疟疾患儿与 CC 患儿的消瘦或体重不足发生率无显著差异。入组时的营养不足与死亡率或住院再入院无关，但基线时体重不足或发育迟缓的儿童认知 z 评分低于无此情况的儿童（体重不足，平均差异[95%置信区间（CI）]-0.98[-1.66，-0.31]，-0.72[-1.16，-0.27]和-0.61[-1.08，-0.13]；发育迟缓，-0.70[-1.25，-0.15]，-0.73[-1.16，-0.31]和-0.61[-0.96，-0.27]）；CM、SMA 和 CC 分别）。
在患有严重疟疾的儿童中，治疗后消瘦和体重不足会恢复到人群水平。然而，入组时发育迟缓或体重不足与 CC 和严重疟疾患儿的长期认知能力较差有关。
