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BackgroundNutritional 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.MethodAdult 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.ResultsWe 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 (pp=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).ConclusionsFaster 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.

BackgroundNutritional rehabilitation during severe malnutrition (SM) aims to rapidly restore body size and minimize poor short-term outcomes. We hypothesized that too rapid weight gain during and after treatment might however predispose to cardiometabolic risk in adult life.MethodsWeight and height during hospitalization and one year post-hospitalization were abstracted from hospital records of children who survived SM. Six definitions of post-malnutrition weight gain/growth were analysed as continuous variables, quintiles and latent classes in age-sex and minimum weight-for-age z-scores-adjusted regression models against adult anthropometry, body composition (DEXA), blood pressure, blood glucose, insulin, and lipids.Results60% of 278 participants were male, mean (SD) age 28.2 (7.7) years, mean (SD) BMI 23.6 (5.2) kg/m2. Mean admission age for SM was 10.9 months (range 0.3-36.3 months) and 207/270 (77%) were wasted (weight-for-height z-score12.9 g/kg/day was associated with higher adult BMI (difference=0.5kg/m2, 95%CI: 0.1-0.9,p= 0.02), waist circumference (difference=1.4cm, 95%CI: 0.4-2.4,p=0.005), fat mass (difference = 1.1kg, 95%CI: 0.2-2,p=0.02), fat mass index (difference=0.32, 95%CI: -0.0001-0,p=0.05), and android fat mass (difference=0.09 kg, 95%CI: 0.01-0.2,p=0.03). Rehabilitation (g/month) and post-hospitalization (g/kg/month) weight gain were associated with greater lean mass (difference = 0.7 kg, 95% CI: 0.1, 1.3,p= 0.02) (difference=1.3kg, 95% CI: 0.3-2.4,p=0.015) respectively.ConclusionRehabilitation weight gain exceeding 13g/kg/day was associated with adult adiposity in young, normal-weight adult SM survivors. This raises questions around existing malnutrition weight gain targets and warrants further studies exploring optimal post-malnutrition growth.