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Thompson DS, Bourdon C, Massara P, Boyne MS, Forrester TE, Gonzales GB, Bandsma RHJ. Childhood severe acute malnutrition is associated with metabolic changes in adulthood. JCI Insight 2020; 5:141316. [PMID: 33201860 PMCID: PMC7819749 DOI: 10.1172/jci.insight.141316] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022] Open
Abstract
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-DAs) assessed differences in metabolic profiles and identified the most discriminative metabolites. RESULTS Seventy-seven 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 with CPs, SAM survivors had less liver fat; higher branched-chain 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 nonstunted SAM survivors. CONCLUSION 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 with CPs. 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 at the 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.
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Affiliation(s)
- Debbie S Thompson
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada.,Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.,Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Paraskevi Massara
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Michael S Boyne
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica.,Department of Medicine, The University of the West Indies, Kingston, Jamaica
| | - Terrence E Forrester
- University of the West Indies Solutions for Developing Countries, Kingston, Jamaica
| | - Gerard Bryan Gonzales
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada.,Gastroenterology, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Robert H J Bandsma
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada.,Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
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Leite HP, de Lima LFP, de Oliveira Iglesias SB, Pacheco JC, de Carvalho WB. Malnutrition May Worsen the Prognosis of Critically Ill Children With Hyperglycemia and Hypoglycemia. JPEN J Parenter Enteral Nutr 2012; 37:335-41. [DOI: 10.1177/0148607112458124] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Heitor Pons Leite
- Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
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Mathangi DC, Deepa R, Mohan V, Govindarajan M, Namasivayam A. Long-term ingestion of cassava (tapioca) does not produce diabetes or pancreatitis in the rat model. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 2000; 27:203-8. [PMID: 10952402 DOI: 10.1385/ijgc:27:3:203] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cassava (tapioca, manihot) is consumed as a staple food in some developing countries. The intake of cassava has been linked to several diseases including fibrocalculous pancreatic diabetes (tropical calcific pancreatitis). There are few long-term studies on the effect of cassava ingestion on the pancreas in animal models. This article reports on the long-term (up to 1 yr) effects of cassava in the rat model. We found that cassava did not produce diabetes in the rat even after a year of cassava feeding. There were transient changes in serum insulin and lipase levels, but the significance of these findings are not clear. There was no histopathological evidence of either acute or chronic pancreatitis, but there were changes of toxic hepatitis in the liver. In conclusion, chronic cassava ingestion up to a year does not lead to either diabetes or chronic pancreatitis in the rat model.
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Affiliation(s)
- D C Mathangi
- Department of Physiology, DrALM. PG Institute of Basic Medical Sciences, University of Madras, Taramani, India
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