title: Impaired Bile Acid Homeostasis in Children with Severe Acute Malnutrition.
abstract: Severe acute malnutrition (SAM) is a major cause of mortality in children under 5 years and is associated with hepatic steatosis. Bile acids are synthesized in the liver and participate in dietary fat digestion, regulation of energy expenditure, and immune responses. The aim of this work was to investigate whether SAM is associated with clinically relevant changes in bile acid homeostasis.
  
  
  
  An initial discovery cohort with 5 healthy controls and 22 SAM-patients was used to identify altered bile acid homeostasis. A follow up cohort of 40 SAM-patients were then studied on admission and 3 days after clinical stabilization to assess recovery in bile acid metabolism. Recruited children were 6-60 months old and admitted for SAM in Malawi. Clinical characteristics, feces and blood were collected on admission and prior to discharge. Bile acids, 7α-hydroxy-4-cholesten-3-one (C4) and FGF-19 were quantified.
  
  
  
  On admission, total serum bile acids were higher in children with SAM than in healthy controls and glycine-conjugates accounted for most of this accumulation with median and interquartile range (IQR) of 24.6 μmol/L [8.6-47.7] compared to 1.9 μmol/L [1.7-3.3] (p = 0.01) in controls. Total serum bile acid concentrations did not decrease prior to discharge. On admission, fecal conjugated bile acids were lower and secondary bile acids higher at admission compared to pre- discharge, suggesting increased bacterial conversion. FGF19 (Fibroblast growth factor 19), a marker of intestinal bile acid signaling, was higher on admission and was associated with decreased C4 concentrations as a marker of bile acid synthesis. Upon recovery, fecal calprotectin, a marker of intestinal inflammation, was lower.
  
  
  
  SAM is associated with increased serum bile acid levels despite reduced synthesis rates. In SAM, there tends to be increased deconjugation of bile acids and conversion from primary to secondary bile acids, which may contribute to the development of liver disease.
authors.affiliation: Physiology and Experimental Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Paediatrics & Children Health, College of Medicine, P/Bag 360, University of Malawi, Blantyre, Malawi.|Global Child Health Group, Emma Children's Hospital/AMC, Amsterdam, The Netherlands.
authors.forename: Wieger
authors.initials: W
authors.lastname: Voskuijl
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Marialena
authors.initials: M
authors.lastname: Mouzaki
authors.affiliation: Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Albert K
authors.initials: AK
authors.lastname: Groen
authors.affiliation: Physiology and Experimental Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Alexander
authors.affiliation: Physiology and Experimental Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Celine
authors.initials: C
authors.lastname: Bourdon
authors.affiliation: Physiology and Experimental Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Alice
authors.initials: A
authors.lastname: Wang
authors.affiliation: Physiology and Experimental Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Versloot
authors.affiliation: Physiology and Experimental Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Valeria
authors.initials: V
authors.lastname: Di Giovanni
authors.affiliation: Laboratory Genetic Metabolic Diseases, Departments of Pediatrics and Clinical Chemistry, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Ronald J A
authors.initials: RJ
authors.lastname: Wanders
authors.affiliation: Physiology and Experimental Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Canada.|Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.|Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Bandsma
mesh_terms: D001647:Bile Acids and Salts / Q000097:blood*; D016022:Case-Control Studies; D002675:Child, Preschool; D002783:Cholestenones / Q000378:metabolism*; D004041:Dietary Fats / Q000627:therapeutic use*; D005234:Fatty Liver / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control*; D005243:Feces / Q000737:chemistry; D005260:Female; D005346:Fibroblast Growth Factors / Q000378:metabolism*; D006706:Homeostasis / Q000187:drug effects; D006801:Humans; D007223:Infant; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism; D008099:Liver / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D008297:Male; D000067011:Severe Acute Malnutrition / Q000178:diet therapy* / Q000378:metabolism / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D001647:Bile Acids and Salts; D002783:Cholestenones; D004041:Dietary Fats; C117476:FGF19 protein, human; D039841:Leukocyte L1 Antigen Complex; C002656:7 alpha-hydroxy-4-cholesten-3-one; D005346:Fibroblast Growth Factors