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Rates of growth during and after nutritional rehabilitation and liver fat in adult survivors of severe acute malnutrition

Background: Nutritional rehabilitation during severe malnutrition (SM) aims to quickly restore a healthy body weight, but rapid weight gain has been associated with later cardiovascular risk. We hypothesized that faster weight gain during SM rehabilitation and post-hospitalization is associated with liver fat in adult survivors. Method: Adult survivors of childhood SM underwent abdominal CT scan to estimate liver fat as mean liver attenuation (MLA) and liver spleen ratio (L/S). Birth weight (BW) and anthropometry measured during, and post-hospitalization were abstracted from admission records. Results: We studied 42 marasmus survivors (Ms) and 40 kwashiorkor survivors (Ks). Ms had a lower mean BW (SD) 2.5 (0.8) vs 3.0 (0.7) kg; p=0.01) and were more wasted (p<0.001) and stunted (p=0.03) than Ks on admission to hospital. Ms and Ks had similar rates of rehabilitation weight gain, which was inversely associated with MLA among all survivors of SM (r=-0.246, p=0.029), but only in Ms when assessed by diagnosis (r= -0.449, p=0.004). The association between rehabilitation weight gain and adult liver fat in Ms was not altered by BW, admission wasting or stunting. In Ks, post-hospitalization height gain was inversely associated with MLA (difference = -0.64, 95%CI: -0.64 to -0.13; p=0.006). Conclusions: Faster rehabilitation weight gain is associated with liver fat in adult survivors of childhood severe malnutrition. The finding that birth weight did not influence these outcomes may reflect the timing of the nutritional insult in utero. Target weight gain during nutritional rehabilitation may need to be lowered to optimize long-term outcomes in these children.