Correlates of gut function in children hospitalized for severe acute malnutrition, a cross-sectional study in Uganda

Research output: Contribution to journalJournal articleResearchpeer-review

Betty Lanyero, Benedikte Grenov, Nicolette Nabukeera Barungi, Hanifa Namusoke, Kim F. Michaelsen, Ezekiel Mupere, Christian Mølgaard, Pingping Jiang, Hanne Frøkiær, Maria Wiese, Musemma Kedir Muhammed, Hannah Pesu, Dennis Sandris Nielsen, Henrik Friis, Maren Johanne Heilskov Rytter, Vibeke Brix Christensen

Objective: Children with severe acute malnutrition (SAM) may have impaired intestinal function which can result in malabsorption, diarrhoea and poor growth. This study evaluated the gut function of children with SAM using fecal and blood biomarkers and assessed their correlates.

Methods: A cross-sectional study, nested in a randomized trial (www.isrctn.com, ISRCTN 16454889), was conducted at Mulago hospital, Uganda among subgroups of 400 children with complicated SAM and 30 community controls. Gut function was evaluated by five biomarkers: plasma citrulline, fecal myeloperoxidase and fecal neopterin, bacterially derived 16S rRNA gene and internal transcribed Spacer region (ITS) specific for Candida spp. in blood.

Results: Compared to controls, children with SAM had lower median plasma citrulline (5.14 vs. 27.4 μmol/l, P  <  0.001), higher median fecal myeloperoxidase (18083 vs 7482 ng/ml, P  =  0.001) and fecal neopterin (541 vs 210 nmol/l, P  < 0.001). A higher blood concentration of 16S rRNA gene copy numbers was observed among children with SAM (95 vs 28 copies/μl, P  =  0.05), while there was no difference in the blood concentration of Candida-specific ITS fragment. Among those with SAM, plasma citrulline was lower in children with oedema, diarrhoea, dermatosis, and plasma C-reactive protein (CRP) >10 mg/l. Fecal neopterin was positively correlated with symptoms of fever and cough whereas it was negatively correlated with mid-upper arm circumference (MUAC), weight-for-height (WHZ), oedema, and dermatosis

Conclusion: Children with complicated SAM seem to have impaired gut function characterized by reduced enterocyte mass, intestinal inflammation, and increased bacterial translocation.

Original languageEnglish
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume69
Issue number3
Pages (from-to)292-298
Number of pages6
ISSN0277-2116
DOIs
Publication statusPublished - 2019

ID: 222093390