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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Severe acute malnutrition in childhood: Hormonal and metabolic status at presentation, response to treatment, and predictors of mortality
Journal of Clinical Endocrinology and Metabolism, Volume 99, No. 6, Year 2014
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Description
Objective: Malnutrition is a major cause of childhood morbidity and mortality. To identify and target those at highest risk, there is a critical need to characterize biomarkers that predict complications prior to and during treatment. Methods: We used targeted and nontargeted metabolomic analysis to characterize changes in a broad array of hormones, cytokines, growth factors, and metabolites during treatment of severe childhood malnutrition. Children aged 6 months to 5 years were studied at presentation to Mulago Hospital and during inpatient therapy with milk-based formulas and outpatient supplementation with ready-to-use food.We assessed the relationship between baseline hormone and metabolite levels and subsequent mortality. Results: Seventy-seven patientswereenrolled in the study; a subsetwasfollowedupfrom inpatient treatment to the outpatient clinic. Inpatient and outpatient therapies increased weight/height z scores and induced striking changes in the levels of fatty acids, amino acids, acylcarnitines, inflammatory cytokines, and various hormones including leptin, insulin, GH, ghrelin, cortisol, IGF-I, glucagon- like peptide-1, and peptide YY.Atotal of 12.2% of the patients died during hospitalization; the major biochemical factor predicting mortality was a low level of leptin (P .0002), a marker of adipose tissue reserve and a critical modulator of immune function. Conclusions: We have used metabolomic analysis to provide a comprehensive hormonal and metabolic profile of severely malnourished children at presentation and during nutritional rehabilitation. Our findings suggest that fatty acid metabolism plays a central role in the adaptation to acute malnutritionandthatlowlevels of the adipose tissuehormoneleptin associate with,andmay predict, mortality prior to and during treatment. © 2014 by the Endocrine Society.
Authors & Co-Authors
Bartz, Sarah
United States, Durham
Duke University Medical Center
Mody, Aaloke
United States, Durham
Duke University Medical Center
Hornik, Christoph P.
United States, Durham
Duke Clinical Research Institute
Bain, James R.
United States, Durham
Duke University Medical Center
Muehlbauer, Michael J.
United States, Durham
Duke University Medical Center
Kiyimba, Tonny
Uganda, Kampala
Mulago Hospital
Kiboneka, Elizabeth
Uganda, Kampala
Mulago Hospital
Stevens, Robert D.
United States, Durham
Duke University Medical Center
Bartlett, John A.
United States, Durham
Duke University Medical Center
St. Peter, John V.
United States, New York
Pepsico, Inc.
Newgard, Christopher B.
United States, Durham
Duke University Medical Center
Freemark, Michael S.
United States, Durham
Duke University Medical Center
Statistics
Citations: 151
Authors: 12
Affiliations: 4
Identifiers
Doi:
10.1210/jc.2013-4018
ISSN:
0021972X
e-ISSN:
19457197
Research Areas
Disability
Food Security
Health System And Policy
Maternal And Child Health
Noncommunicable Diseases