Identification of severely malnourished children at high risk for death:

Arvidsson Kvissberg, M.E. (Matilda) (2016) Identification of severely malnourished children at high risk for death:. thesis, Medicine.

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Abstract

Introduction: Severe acute malnutrition (SAM) accounts for over half a million child deaths per year, with an inpatient mortality up to as high as 30%. SAM can present as either severe wasting, known as marasmus, or as bilateral pitting edema, known as kwashiorkor. Mortality in SAM is associated to hypoglycemia, indicating metabolic dysfunction. By comparing the metabolic urine profiles of children who die from SAM to children who recover we aim to better understand the pathophysiology of SAM and potentially uncover a non-invasive predictive biomarker for morality. Methods: We used untargeted nuclear magnetic resonance (NMR) spectroscopy to analyze the metabolic urine profiles of 69 children with SAM. Using sex and age corrected generalized linear models we compared the metabolic profiles of children who died to those who survived, and children with kwashiorkor to children with marasmus. Results: Three metabolites differed significantly between the deceased and recovered group: lactic acid (0.29 mM vs 0. 12 mM, p < 0.001), succinic acid (0.09 mM vs 0.00 mM, p < 0.001) and ß-hydroxybutyric acid (0.02 mM vs 0.00 mM, p = 0.01). There was no significant difference between the metabolic profiles of children with kwashiorkor compared to children with marasmus. Discussion: The increased lactic acid and succinic acid levels indicate malnutrition-induced mitochondrial dysfunction leading to anaerobic glycolysis under aerobic conditions for energy production. The increase in ß-hydroxybutyric acid could be due to the utility of ketones as an energy source. Further studies are needed to determine the validity of these metabolites as biomarkers to predict poor clinical outcome.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Bandsma, Dr. R.H.J.MD and Department of Pediatrics, University Medical Centre Groninge
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:39
Last Modified:	25 Jun 2020 10:39
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/112

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