Associations of prior wasting malnutrition with later indicators of glucose tolerance across 4 countries in Africa and Asia: The Severe Acute Malnutrition - the Role of the Pancreas (SAMPA) study.

BACKGROUND

Prenatal or infant wasting malnutrition followed by later overweight is associated with increased risk of chronic diseases, including type 2 diabetes.

OBJECTIVES

In a pooled analysis of 6 longitudinal cohorts, we investigated associations between prior malnutrition (PM) early in life or in adulthood and subsequent glycemic status.

METHODS

We identified cohorts in Tanzania, Zambia, India, and the Philippines in whom low birth weight or wasting malnutrition in childhood or as adults following human immunodeficiency virus or tuberculosis infection had been measured. Anthropometry, body composition, and glycemic status, determined by hemoglobin A1c (HbA1c), and glucose at 120 min in an oral glucose tolerance test (glucose120), were assessed 3-38 y after PM and in non-PM (NPM) controls. HbA1c and glucose120 were compared between PM and NPM participants by linear regression, controlling for age, sex, and socioeconomic status and, in pooled analyses, for cohort also.

RESULTS

In the full cohort of 2251 participants, there was no overall association between PM and diabetes risk. Child participants aged ∼12 y who were hospitalized with PM when <2 y had higher glucose120 compared to NPM (difference 0.50 mmol/L; 95% CI: 0.10, 0.91 mmol/L). In pooled analyses across adult cohorts controlling for cohort, age, sex, and socioeconomic status, PM participants, compared to NPM, may have higher glucose120 (difference 0.33 mmol/L; 95% CI: -0.27, 0.92 mmol/L) if still underweight, and higher HbA1c (difference 0.41%; 95% CI: -0.07%, 0.89%) and glucose120 (difference 0.70 mmol/L; 95% CI: -0.25, 1.66 mmol/L) if currently obese.

CONCLUSIONS

Childhood PM is associated with greater adult dysglycemia, whereas adulthood PM may have heterogeneous outcomes dependent on subsequent presence/absence of weight gain. Clinicians and public health managers should be aware of the long-term risk and intervene to promote some weight gain but prevent excess weight gain in people who were previously malnourished.