Growth and metabolism in children with acute illness and malnutrition

Introduction: Malnutrition in childhood is related to mortality, mainly from infections, and has long-term health consequences. The impact of an acute illness on subsequent growth of malnourished children has been poorly described and there is limited understanding of the acute and long-term metabolic changes in these children.
Aims: This thesis aimed to understand the growth recovery processes and metabolic disturbances linked to acute illness and malnutrition and whether these differ between children with severe wasting (SW) versus nutritional oedema (NO).
Methods: Growth was measured in children hospitalised in low- and middle- income countries with classic anthropometry or with bio-impedance analysis (BIA) for body composition. Blood glucose was tracked with continuous glucose monitoring, and the recovery dynamics of hundreds of metabolites was investigated over short and longer-term convalescence to identify metabolic pathways with rapid or delayed recovery.
Results: Most children had sub-optimal growth post-discharge but children with NO had a distinct weight-recovery pattern. While BIA did not add prognostic value, continuous glucose monitoring revealed that half the children experience severe glucose dysregulation, including severe hypoglycemia that can led to death. Metabolomics analysis showed that while amino acids normalise, large panels of specialised lipids show delayed recovery.
Conclusion: Enhancing metabolism by optimizing therapeutic feeds or developing adjuvant therapy could improve glucose regulation and replenish lipids needed for cellular repair. Since metabolic distress is linked to mortality in malnourished children, developing tailored interventions could broaden the treatment approaches and improve not only growth but also mortality in children with acute illnesses and malnutrition.