Abstract:
Background: Rapid growth should occur among children with severe malnutrition (SM) with
medical and nutritional management. Systemic inflammation (SI) is associated with death among
children with SM and is negatively associated with linear growth. However, the relationship
between SI and weight gain during therapeutic feeding following acute illness is unknown. We
hypothesised that growth post-hospital discharge is associated with SI among children with SM.
Methods: We conducted secondary analysis of data from HIV-uninfected children with SM (n=98)
who survived and were not readmitted to hospital during one year of follow-up. We examined the
relationship between changes in absolute deficits in weight and mid-upper-arm circumference
(MUAC) from enrolment at stabilisation to 60 days and one year later, and untargeted plasma
proteome, targeted cytokines/chemokines, leptin, and soluble CD14 using multivariate regularized
linear regression. Results: The mean change in absolute deficit in weight and MUAC was -0.50kg
(standard deviation; SD±0.69) and -1.20cm (SD±0.89), respectively, from enrolment to 60 days
later. During the same period, mean weight and MUAC gain was 3.3g/kg/day (SD±2.4) and
0.22mm/day (SD±0.2), respectively. Enrolment interleukins; IL17-alpha and IL-2, and serum
amyloid P were negatively associated with weight and MUAC gain during 60 days.
Lipopolysaccharide binding protein and complement component 2 were negatively associated with
weight gain only. Leptin was positively associated with weight gain. Soluble CD14, beta-2
microglobulin, and macrophage inflammatory protein 1 beta were negatively associated with
MUAC gain only. Glutathione peroxidase 3 was positively associated with weight and MUAC
gain during one year. Conclusions: Early post-hospital discharge weight and MUAC gain were
rapid and comparable to children with uncomplicated SM treated in the community. Higher
concentrations of SI markers were associated with less weight and MUAC gain, suggesting
inflammation negatively impacts recovery from wasting. This finding warrants further research on
reducing inflammation on growth among children with SM.