Intestinal disturbances associated with mortality of children with complicated severe malnutrition
<p><strong>Background: </strong>Children admitted to hospital with complicated severe malnutrition (CSM) have high mortality despite compliance with standard WHO management guidelines. Limited data suggests a relationship between intestinal dysfunction and poor prognosis i...
| Hoofdauteurs: | , , , , , , , , , , , |
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| Formaat: | Journal article |
| Taal: | English |
| Gepubliceerd in: |
Springer Nature
2023
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| _version_ | 1826311944627290112 |
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| author | Wen, B Farooqui, A Bourdon, C Tarafdar, N Ngari, M Chimwezi, E Thitiri, J Mwalekwa, L Walson, JL Voskuijl, W Berkley, JA Bandsma, RHJ |
| author_facet | Wen, B Farooqui, A Bourdon, C Tarafdar, N Ngari, M Chimwezi, E Thitiri, J Mwalekwa, L Walson, JL Voskuijl, W Berkley, JA Bandsma, RHJ |
| author_sort | Wen, B |
| collection | OXFORD |
| description | <p><strong>Background: </strong>Children admitted to hospital with complicated severe malnutrition (CSM) have high mortality despite compliance with standard WHO management guidelines. Limited data suggests a relationship between intestinal dysfunction and poor prognosis in CSM, but this has not been explicitly studied. This study aimed to evaluate the role of intestinal disturbances in CSM mortality.</p>
<p><strong>Methods: </strong>A case-control study nested within a randomized control trial was conducted among children hospitalized with CSM in Kenya and Malawi. Children who died (cases, <em>n</em> = 68) were compared with those who were discharged, propensity matched to the cases on age, HIV and nutritional status (controls, <em>n</em> = 68) on fecal metabolomics that targeted about 70 commonly measured metabolites, and enteropathy markers: fecal myeloperoxidase (MPO), fecal calprotectin, and circulating intestinal fatty acid binding protein (I-FABP).</p>
<p><strong>Results: </strong>The fecal metabolomes of cases show specific reductions in amino acids, monosaccharides, and microbial fermentation products, when compared to controls. SCFA levels did not differ between groups. The overall fecal metabolomics signature moderately differentiates cases from controls (AUC = 0.72). Enteropathy markers do not differ between groups overall, although serum I-FABP is elevated in cases in a sensitivity analysis among non-edematous children. Integrative analysis with systemic data suggests an indirect role of intestinal inflammation in the causal path of mortality.</p>
<p><strong>Conclusions: </strong>Intestinal disturbances appear to have an indirect association with acute mortality. Findings of the study improve our understanding of pathophysiological pathways underlying mortality of children with CSM.</p> |
| first_indexed | 2024-03-07T08:20:15Z |
| format | Journal article |
| id | oxford-uuid:77b468b7-af04-4c4e-9574-f84d931fba4b |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:20:15Z |
| publishDate | 2023 |
| publisher | Springer Nature |
| record_format | dspace |
| spelling | oxford-uuid:77b468b7-af04-4c4e-9574-f84d931fba4b2024-01-23T14:59:07ZIntestinal disturbances associated with mortality of children with complicated severe malnutritionJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:77b468b7-af04-4c4e-9574-f84d931fba4bEnglishSymplectic ElementsSpringer Nature2023Wen, BFarooqui, ABourdon, CTarafdar, NNgari, MChimwezi, EThitiri, JMwalekwa, LWalson, JLVoskuijl, WBerkley, JABandsma, RHJ<p><strong>Background: </strong>Children admitted to hospital with complicated severe malnutrition (CSM) have high mortality despite compliance with standard WHO management guidelines. Limited data suggests a relationship between intestinal dysfunction and poor prognosis in CSM, but this has not been explicitly studied. This study aimed to evaluate the role of intestinal disturbances in CSM mortality.</p> <p><strong>Methods: </strong>A case-control study nested within a randomized control trial was conducted among children hospitalized with CSM in Kenya and Malawi. Children who died (cases, <em>n</em> = 68) were compared with those who were discharged, propensity matched to the cases on age, HIV and nutritional status (controls, <em>n</em> = 68) on fecal metabolomics that targeted about 70 commonly measured metabolites, and enteropathy markers: fecal myeloperoxidase (MPO), fecal calprotectin, and circulating intestinal fatty acid binding protein (I-FABP).</p> <p><strong>Results: </strong>The fecal metabolomes of cases show specific reductions in amino acids, monosaccharides, and microbial fermentation products, when compared to controls. SCFA levels did not differ between groups. The overall fecal metabolomics signature moderately differentiates cases from controls (AUC = 0.72). Enteropathy markers do not differ between groups overall, although serum I-FABP is elevated in cases in a sensitivity analysis among non-edematous children. Integrative analysis with systemic data suggests an indirect role of intestinal inflammation in the causal path of mortality.</p> <p><strong>Conclusions: </strong>Intestinal disturbances appear to have an indirect association with acute mortality. Findings of the study improve our understanding of pathophysiological pathways underlying mortality of children with CSM.</p> |
| spellingShingle | Wen, B Farooqui, A Bourdon, C Tarafdar, N Ngari, M Chimwezi, E Thitiri, J Mwalekwa, L Walson, JL Voskuijl, W Berkley, JA Bandsma, RHJ Intestinal disturbances associated with mortality of children with complicated severe malnutrition |
| title | Intestinal disturbances associated with mortality of children with complicated severe malnutrition |
| title_full | Intestinal disturbances associated with mortality of children with complicated severe malnutrition |
| title_fullStr | Intestinal disturbances associated with mortality of children with complicated severe malnutrition |
| title_full_unstemmed | Intestinal disturbances associated with mortality of children with complicated severe malnutrition |
| title_short | Intestinal disturbances associated with mortality of children with complicated severe malnutrition |
| title_sort | intestinal disturbances associated with mortality of children with complicated severe malnutrition |
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