Gizaw Getu, Wells Jonathan Ck, Argaw Alemayehu, Olsen Mette Frahm, Abdissa Alemseged, Asres Yaregal, Challa Feyissa, Berhane Melkamu, Abera Mubarek, Sadler Kate, Boyd Erin, Friis Henrik, Girma Tsinuel, Wibaek Rasmus
Department of Human Nutrition and Dietetics, Jimma University, Jimma, Ethiopia; Jimma University Clinical and Nutrition Research Partnership, Jimma University, Jimma, Ethiopia; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Childhood Nutrition Research Centre, Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.
Am J Clin Nutr. 2025 Feb;121(2):343-354. doi: 10.1016/j.ajcnut.2024.12.014. Epub 2024 Dec 18.
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.
We evaluated cardiometabolic risk in children with SAM treated through community-based management, relative to controls, 5-y postrecovery. Recognizing the heterogeneity of SAM case definitions and patterns of nutritional recovery, we also identified distinct body mass index-for-age z-score (BAZ) trajectories of children with SAM in the first year postrecovery and examined their associations with anthropometry, body composition, and cardiometabolic risk markers, relative to controls, 5-y postrecovery.
A prospective cohort study in 2013 enrolled children aged 6-59 mo, recovered from SAM (n = 203), or nonwasted controls (n = 202), in Jimma Zone, Ethiopia. Anthropometry, body composition, and cardiometabolic markers were assessed 5 y postrecovery. Multiple linear regression models compared outcomes between SAM-recovered children and controls. We used latent class trajectory modeling to identify BAZ trajectories in the first year postrecovery and compared these trajectory groups with controls.
We traced 291 (71.9%) children (mean age 6.2 y) at 5-y follow-up. Overall, compared with 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 with controls, all BAZ trajectories except "decrease-increase" had lower weight, height, and fat-free mass index. Compared with controls, the "decrease-increase" trajectory had lower glucose [-15.8 mg/dL; 95% confidence interval (CI): -31.2, -0.4], whereas the "increase-decrease" trajectory had higher glucose (8.1 mg/dL; 95% CI: -0.8, 16.9). Compared with controls, the "decrease-increase" and "decrease" trajectories had higher total cholesterol (24.3 mg/dL; 95% CI: -9.4, 58.4) and low-density lipoprotein cholesterol (10.4 mg/dL; 95% CI: -3.8, 24.7), respectively. The "increase" trajectory had the lowest cardiometabolic risk.
Both rapid BAZ increase and decrease during early postrecovery from SAM were associated with greater cardiometabolic risk 5 y later. The findings indicate the need to target postrecovery interventions to optimize healthy weight recovery.
胎儿生长受损和出生后生长加速与心脏代谢疾病有关。很少有研究调查从重度急性营养不良（SAM）恢复后与儿童心脏代谢风险之间的关联。
我们评估了通过社区管理治疗的SAM儿童在恢复后5年相对于对照组的心脏代谢风险。认识到SAM病例定义和营养恢复模式的异质性，我们还确定了SAM儿童在恢复后第一年不同的年龄别体重指数Z评分（BAZ）轨迹，并研究了这些轨迹与人体测量学、身体成分以及恢复后5年相对于对照组的心脏代谢风险标志物之间的关联。
2013年在埃塞俄比亚的吉马地区进行了一项前瞻性队列研究，纳入了6至59个月大、已从SAM恢复的儿童（n = 203）或非消瘦对照组（n = 202）。在恢复后5年评估人体测量学、身体成分和心脏代谢标志物。多个线性回归模型比较了SAM恢复儿童与对照组之间的结果。我们使用潜在类别轨迹模型来确定恢复后第一年的BAZ轨迹，并将这些轨迹组与对照组进行比较。
在5年随访中追踪到了291名（71.9%）儿童（平均年龄6.2岁）。总体而言，与对照组相比，SAM恢复儿童在心脏代谢风险方面没有差异。我们在SAM恢复儿童中确定了4种BAZ轨迹：“增加”（74.6%）、“减少”（11.0%）、“先减少后增加”（5.0%）和“先增加后减少”（9.4%）。与对照组相比，除“先减少后增加”外的所有BAZ轨迹的体重、身高和去脂体重指数均较低。与对照组相比，“先减少后增加”轨迹的血糖较低[-15.8mg/dL；95%置信区间（CI）：-31.2，-0.4]，而“先增加后减少”轨迹的血糖较高（8.1mg/dL；95%CI：-0.8，16.9）。与对照组相比，“先减少后增加”和“减少”轨迹的总胆固醇分别较高（24.3mg/dL；95%CI：-9.4，58.4）和低密度脂蛋白胆固醇较高（10.4mg/dL；95%CI：-3.8，24.7）。“增加”轨迹的心脏代谢风险最低。
SAM恢复后早期BAZ的快速增加和减少均与5年后更大的心脏代谢风险相关。研究结果表明需要针对恢复后的干预措施来优化健康体重恢复。
