Long-term effects of severe acute malnutrition on lung function in Malawian children: a cohort study.
Lelijveld, Natasha;
Kerac, Marko;
Seal, Andrew;
Chimwezi, Emmanuel;
Wells, Jonathan C;
Heyderman, Robert S;
Nyirenda, Moffat J;
Stocks, Janet;
Kirkby, Jane;
(2017)
Long-term effects of severe acute malnutrition on lung function in Malawian children: a cohort study.
The European respiratory journal, 49 (4).
p. 1601301.
ISSN 0903-1936
DOI: https://doi.org/10.1183/13993003.01301-2016
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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 FEV1 z-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.