Table 3

Summary of studies examining effects of documented severe malnutrition in childhood on non-communicable disease (NCD) outcomes

StudySetting and populationType/timing of severe malnutrition (SM) exposureOutcomesKey findings*Risk-of-bias score
(IV/EV)†
Case-control studies
Chege15Cases: patients with diabetes 61.8±10.9 years, Kenya (n=45)
Controls: age and sex-matched non-diabetics from same area attending outpatient clinics (n=45)
Self-reported episode of SM in childhood
Exposure age not specified
T2D risk factors↑ Childhood SM among diabetics /
Fekadu et al16Cases: insulin-requiring diabetics 18–40 years, Ethiopia (n=107)
Controls: age and sex-matched patients attending other hospital clinics (n=110)
Self-reported episode of childhood SM
Exposure age not specified
Insulin-requiring diabetes risk factors↑ Childhood SM in diabetics·/
Prospective cohort studies
Benefice et al65Ex-malnourished: children 5.5±0.5 years, Senegal (n=52)
Chronic controls: chronically undernourished children (n=54)
Well-nourished controls (WN): age-matched, well-nourished children (n=33)
Marasmus
Median age: 14 months
Motor fitness, anthropometry↓ Handgrip in post-SM versus chronic controls
↓ Height/weight for age versus WN controls
↓ Distance throw, jump, agility/shuttle run versus WN controls
↔ Endurance run
·/
Boulé et al52Ex-malnourished: young men 22.0±3.6 years, Mexico (n=26)
Controls: young men 26.5±2.1 years with no history of SM (n=27)
Marasmus, kwashiorkor
Age at admission: ≤1 years
Insulin sensitivity, abdominal obesity↓ Insulin sensitivity w/ high abdominal fat versus fat-matched controls· /
Bourdon et al77Ex-malnourished: children 9.6±1.6 years, Malawi (n=69)
Sibling controls: closest in age to case child with no history of SM (n=44)
Community controls: age and sex-matched (n=37)
Marasmus and kwashiorkor
Median age at admission: 21.5 months
Cardiometabolic disease markers↔ Metabolites· /
Cook23Ex-malnourished: children 6.7–14.9 years, Uganda (n=31)
Controls: children raised in similar environment as cases with no history of SM (n=21)
Kwashiorkor
Mean age at admission: 1.9 years
Carbohydrate tolerance↓ Glucose clearance
↑ Blood glucose 2 hours post oral glucose tolerance test (OGTT)
· /
Francis-Emmanuel et al53Ex-malnourished: adult marasmus survivors (MS) (n=42) and kwashiorkor survivors (KS) (n=38) 17–50 years, Jamaica
Community controls: age, sex, BMI-matched (n=70)
Birthweight-matched controls: age-matched (n=40)
Marasmus and kwashiorkor
Age at admission: 6–18 months
Glucose metabolism↔ Fasting plasma glucose
↑ Glucose intolerance (MS versus KS)
↓ Insulin sensitivity (MS versus KS)
↔ Insulin sensitivity (MS versus controls)
↓ Insulinogenic and oral disposition indices (MS vs all groups)
·· /
Gonzalez-Barranco et al42Ex-malnourished: young men 20.2±3.6 years, Mexico (n=52)
Controls: young men with no history of SM (n=50)
Marasmus, kwashiorkor
Mean age at admission: 4.5 months
Glucose metabolism, lipid profile, blood pressure (BP)↑ Areas under the curves of glucose and insulin
↓ Insulin sensitivity, BP
↔ Fasting blood glucose, lipid profile
·· /
Idohou-Dossou et al20Ex-malnourished: children 6–8 years, Senegal (n=24)
Sibling controls (SC): closest in age to case child with no history of SM (n=24)
Well-nourished controls (WN): age-matched healthy children from wealthier area (n=19)
Marasmus
Age at admission: 1–3 years
Biochemical nutritional indicators, growth factors, anthropometry↓ Apolipoprotein A↔ versus WN controls, no difference between post-SM and SC
↓ Lean mass in post-SM and SC associated with low IGF-↔
· /
Kajubi24Ex-malnourished: adolescents 11–19 years, Uganda (n=15)
Controls: adolescents with no history of SM (n=11)
Kwashiorkor
Age at admission: 1.5–3 years
Pancreatic function↔ Blood glucose post-OGTT
↓ Fasting plasma insulin
·/
Lelijveld et al9Ex-malnourished: children 9.6±1.6 years, Malawi (n=320)
Sibling controls (SC): closest in age to case child with no history of SM (n=217)
Community controls (CC): age and sex-matched with no history of SM (n=184)
Marasmus, kwashiorkor
Median age at admission: 24 months
Blood markers of NCDs, physical capacity, anthropometry↔ Glucose tolerance, glycosylated haemoglobin, blood lipids, salivary cortisol
↑ Diastolic BP in post-SM versus SC
↓ Handgrip strength versus CC/SC
↓ Lean mass versus CC but similar to SC
··/
Moore et al25Rural adults (mean age 35.8 years), Gambia (n=145)Low weight-for-age z-score (WAZ)
WAZ measured at 18 months
Cardiovascular disease (CVD) risk factors↓ Fasting plasma insulin in lower WAZ quartiles
↔ Fasting blood glucose, blood glucose or insulin post-OGTT, cortisol, BP
··/
Sheppard et al84Ex-malnourished: adult survivors of kwashiorkor (KS) 29.82±9.03 years (n=21) or marasmus (MS) 25.02±5.69 years (n=23), JamaicaMarasmus, kwashiorkor
Mean age at admission: 11 months
Epigenetic profile in muscle tissue↕ Differences in DNA methylation of 63 genes related to, body size/composition, glucose metabolism, musculoskeletal growth, cardiovascular pathways between MS and KS·/
Tennant et al43Ex-malnourished: adult survivors of childhood kwashiorkor (n=62) 27.2±7.8 years and marasmus (n=54) 29.2±8.4 years, Jamaica
Community controls: age and sex matched with no history of SM (n=45)
Marasmus, kwashiorkor
Mean age at admission: 12 months
Cardiovascular structure/function↓ Left ventricular outflow tract parameter, stroke volume, cardiac output, pulse wave velocity
↑ Diastolic BP
↔ Systolic BP
↑ Systemic vascular resistance
↑ Heart rate in MS versus KS
↔ Large vessel, cardiac remodelling
··/
  • Acceptable IV and EV Embedded Image. Poor IV or EV Embedded Image. Poor IV and EV Embedded Image.

  • *Symbols for effect direction: ↑ increased; ↓ decreased; ↕ mixed (indicate statistically significant results were reported, defined as p<0.05); ↔ none (indicates no statistically significant result was reported). If no age group is indicated beside the finding, then all age groups were affected.

  • †The scoring system used in the risk-of-bias assessment is described in the Methods section.

  • T2D, type 2 diabetes.