Research on long-term outcomes of severe childhood malnutrition is scarce. Existing evidence suggests potential associations with cardiometabolic disease and impaired cognition. We aimed to assess outcomes in adolescents who were exposed to severe childhood malnutrition compared with peers not exposed to severe childhood malnutrition. In Long-term Outcomes after Severe Childhood Malnutrition (LOCSM), we followed up adolescents who had 15 years earlier received treatment for severe childhood malnutrition at Queen Elizabeth Central Hospital in Blantyre, Malawi. Adolescents with previous severe childhood malnutrition included in LOCSM had participated in an earlier follow-up study (ChroSAM) at 7 years after treatment for severe childhood malnutrition, where they were compared to siblings and age-matched children in the community without previous severe childhood malnutrition. We measured anthropometry, body composition, strength, glucose tolerance, cognition, behaviour, and mental health during follow-up visits between Sept 9, 2021, and July 22, 2022, comparing outcomes in adolescents exposed to previous severe childhood malnutrition with unexposed siblings and adolescents from the community assessed previously (for ChroSAM) and newly recruited during current follow-up. We used a linear regression model to adjust for age, sex, disability, HIV, and socioeconomic status. This study is registered with the International Standard Randomised Controlled Trial Number Registry (ISRCTN17238083). We followed up 168 previously malnourished adolescents (median age 17·1 years [IQR 16·5 to 18·0]), alongside 123 siblings (18·2 years [15·0 to 20·5]), and 89 community adolescents (17·1 years [16·3 to 18·1]). Since last measured 8 years previously, mean height-for-age Z (HAZ) scores had improved in previously malnourished adolescents (difference 0·33 [95% CI 0·20 to 0·46]) and siblings (0·32 [0·09 to 0·55]), but not in community adolescents (difference –0·01 [–0·24 to 0·23]). Previously malnourished adolescents had sustained lower HAZ scores compared with siblings (adjusted difference –0·32 [–0·58 to –0·05]) and community adolescents (–0·21 [–0·52 to 0·10]). The adjusted difference in hand-grip strength between previously malnourished adolescents and community adolescents was –2·0 kg (–4·2 to 0·3). For child behaviour checklist internalising symptom scores, the adjusted difference for previously malnourished adolescents was 2·8 (0·0 to 5·5) compared with siblings and 2·1 (–0·1 to 4·3) compared with community adolescents. No evidence of differences between previously malnourished adolescents and unexposed groups were found in any of the other variables measured. Catch-up growth into adolescence was modest compared with the rapid improvement seen in childhood, but provides optimism for ongoing recovery of height deficits. We found little evidence of heightened non-communicable disease risk in adolescents exposed to severe childhood malnutrition, although long-term health implications need to be monitored. Further investigation of associated home and environmental factors influencing long-term outcomes is needed to tailor preventive and treatment interventions. The Wellcome Trust.

中文翻译：

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马拉维青少年严重儿童营养不良（LOSCM）后的长期结果：一项前瞻性观察队列研究

关于严重儿童营养不良的长期结果的研究很少。现有证据表明与心脏代谢疾病和认知受损存在潜在关联。我们的目的是评估遭受严重儿童营养不良的青少年与未遭受严重儿童营养不良的同龄人的结果。在严重儿童营养不良 (LOCSM) 后的长期结果中，我们对 15 年前在马拉维布兰太尔伊丽莎白女王中心医院接受严重儿童营养不良治疗的青少年进行了随访。LOCSM 中包括的既往患有严重儿童营养不良的青少年在接受严重儿童营养不良治疗 7 年后参加了一项早期随访研究 (ChroSAM)，将他们与社区中以前没有严重儿童营养不良的兄弟姐妹和年龄匹配的儿童进行了比较。我们在 2021 年 9 月 9 日至 2022 年 7 月 22 日的随访期间测量了人体测量学、身体成分、力量、葡萄糖耐量、认知、行为和心理健康状况，比较了之前经历过严重儿童营养不良的青少年与未经历过严重儿童营养不良的青少年的结果。来自先前评估（针对 ChroSAM）的社区青少年和在当前随访期间新招募的青少年。我们使用线性回归模型来调整年龄、性别、残疾、艾滋病毒和社会经济状况。本研究已在国际标准随机对照试验编号登记处注册 (ISRCTN17238083)。我们对 168 名之前营养不良的青少年（中位年龄 17·1 岁 [IQR 16·5 至 18·0]）、123 名兄弟姐妹（18·2 岁 [15·0 至 20·5]）和 89 名社区青少年（ 17·1 年 [16·3 至 18·1]）。自上次测量 8 年前以来，先前营养不良的青少年（差异 0·33 [95% CI 0·20 至 0·46]）和兄弟姐妹（0·32 [0 ·09 至 0·55]），但社区青少年则不然（差异 –0·01 [–0·24 至 0·23]）。与兄弟姐妹（调整后的差异 –0·32 [–0·58 至 –0·05]）和社区青少年（–0·21 [–0·52 至 0·10]）相比，以前营养不良的青少年的 HAZ 分数较低。先前营养不良的青少年和社区青少年之间的握力调整后差异为 –2·0 kg（–4·2 至 0·3）。对于内化症状评分的儿童行为检查表，先前营养不良的青少年与兄弟姐妹相比的调整差异为 2·8（0·0 至 5·5），与社区青少年相比为 2·1（–0·1 至 4·3）。在测量的任何其他变量中，没有发现任何证据表明以前营养不良的青少年和未暴露于营养不良的青少年之间存在差异。与童年时期的快速改善相比，青春期的追赶性生长较为温和，但为身高缺陷的持续恢复提供了乐观的前景。我们发现几乎没有证据表明暴露于严重儿童营养不良的青少年患非传染性疾病的风险增加，尽管需要监测长期健康影响。需要进一步调查影响长期结果的相关家庭和环境因素，以制定预防和治疗干预措施。威康信托基金会。