title: Long-term effects of severe acute malnutrition on lung function in Malawian children: a cohort study.
abstract: Early nutritional insults may increase risk of adult lung disease. We aimed to quantify the impact of severe acute malnutrition (SAM) on spirometric outcomes 7 years post-treatment and explore predictors of impaired lung function.Spirometry and pulse oximetry were assessed in 237 Malawian children (median age: 9.3 years) who had been treated for SAM and compared with sibling and age/sex-matched community controls. Spirometry results were expressed as z-scores based on Global Lung Function Initiative reference data for the African-American population.Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were low in all groups (mean FEV1z-score: -0.47 for cases, -0.48 for siblings, -0.34 for community controls; mean FVC z-score: -0.32, -0.38, and -0.15 respectively). There were no differences in spirometric or oximetry outcomes between SAM survivors and controls. Leg length was shorter in SAM survivors but inter-group sitting heights were similar. HIV positive status or female sex was associated with poorer FEV1, by 0.55 and 0.31 z-scores, respectively.SAM in early childhood was not associated with subsequent reduced lung function compared to local controls. Preservation of sitting height and compromised leg length suggest "thrifty" or "lung-sparing" growth. Female sex and HIV positive status were identified as potentially high-risk groups.
authors.affiliation: Institute for Global Health, University College London, London, UK natasha.lelijveld.11@ucl.ac.uk.|Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.|Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Natasha
authors.identifier: 0000-0002-8452-0198
authors.initials: N
authors.lastname: Lelijveld
authors.affiliation: Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.|Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.|Leonard Cheshire Disability and Inclusive Development Centre, Dept of Epidemiology and Child Health, University College London, London, UK.
authors.forename: Marko
authors.initials: M
authors.lastname: Kerac
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Seal
authors.affiliation: Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chimwezi
authors.affiliation: Childhood Nutrition Research Centre, UCL Great Ormond Street, Institute of Child Health, University College London, London, UK.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Wells
authors.affiliation: Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.|Division of Infection and Immunity, University College London, London, UK.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heyderman
authors.affiliation: Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.|Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Moffat J
authors.initials: MJ
authors.lastname: Nyirenda
authors.affiliation: Respiratory, Critical Care and Anaesthesia section in III, UCL Great Ormond Street, Institute of Child Health, University College London, London, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Stocks
authors.affiliation: Respiratory, Critical Care and Anaesthesia section in III, UCL Great Ormond Street, Institute of Child Health, University College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Kirkby
mesh_terms: D000293:Adolescent; D049628:Body Size; D016022:Case-Control Studies; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology*; D008295:Malawi; D008297:Male; D015999:Multivariate Analysis; D000067011:Severe Acute Malnutrition / Q000503:physiopathology*; D013147:Spirometry; D014797:Vital Capacity