Background Severe acute malnutrition (SAM) is a major contributor to global mortality in children under 5 years. Mortality has decreased, however the long-term cardiometabolic consequences of SAM and its subtypes, severe wasting (SW) and edematous malnutrition (EM), are not well understood. We evaluated the metabolic profiles of adult SAM survivors using targeted metabolomic analyses. Methods This cohort study of 122 adult SAM survivors (SW=69, EM=53) and 90 age, sex and BMI-matched community participants (CPs) quantified serum metabolites using direct flow injection mass spectrometry combined with reverse-phase liquid chromatography. Univariate and sparse partial least square discriminant analyses (sPLS-DA) assessed differences in metabolic profiles and identified the most discriminative metabolites. Results 77 metabolite variables were significant in distinguishing between SAM survivors (28.4 ± 8.8 years, 24.0 ± 6.1 kg/m2) and CPs (28.4 ± 8.9 years, 23.3 ± 4.4 kg/m2) (mean ± SDs) in univariate and sPLS-DA models. Compared to CPs, SAM survivors had less liver fat, higher branched-chained amino acids (BCAAs), urea cycle metabolites and kynurenine-tryptophan (KT) ratio (p<0.001) and lower β-hydroxybutyric acid and acylcarnitine:free carnitine ratio (p<0.001) which were both associated with hepatic steatosis (p<0.001). SW and EM survivors had similar metabolic profiles as did stunted and non-stunted SAM survivors. Conclusions Adult SAM survivors have distinct metabolic profiles that suggest reduced β-oxidation and greater risk of type 2 diabetes (BCAAs, KT ratio, urea cycle metabolites) compared to community participants. This indicates that early childhood SAM exposure has long-term metabolic consequences that may worsen with age and require targeted clinical management. Funding Health Research Council of New Zealand Caribbean Public Health Agency Centre for Global Child Health, Hospital for Sick Children. DST is an Academic Fellow and a Restracomp Fellow at the Centre for Global Child Health GBG is a postdoctoral fellow of the Research Foundation Flanders (FWO).
Debbie S. Thompson, Celine Bourdon, Paraskevi Massara, Michael S. Boyne, Terrence Forrester, Gerard Bryan Gonzales, Robert HJ Bandsma