What Are The Long Term Metabolic Effects Of Childhood Malnutrition?

in steemstem •  4 months ago

Today lets briefly discuss a bleak topic. Childhood malnutrition. Getting adequate, nutritious food to children in developing countries is a known problem, and despite the collective efforts of people around the world upwards of 45% of all deaths in children were still due to the effects of lacking enough good food. [1] However, not all children that experience malnutrition succumb to it, some survive and not a lot is known about what the long term effects are on their metabolic processes down the line. Especially considering many of the surviving malnourished children go on to eat "normal" diets later in life (ones which are higher in fat and sugars).



Image reproduced from Wikipedia


The authors of a recent PLoS One article sought to address this, and this article is what we will be discussing today.

Malnutrition

It is known that severe malnutrition can lead to issues such as: hepatic steatosis ( this is the accumulation of fat in the liver ) and diabetes (the inability to appropriately regulate blood glucose levels) resulting from improperly functioning pancreatic Beta cells. [3], [4]

In this study the authors were looking at mice (yes I know, another mouse model...), the mice were raised malnourished for four weeks (or not) and then provided a high fat/high sugar diet. The sample sizes in this study were quite small (n = 4 or more per group). However that does not mean we can not discuss their data.

Some Results

Reproduced From [2] Figure 1C

To the left we are looking at the average weights from the mice included in the study at the various steps along the way. In the first plot we see the weights of the mice who were on the normal diet, which included protein (NPD), and the malnourished diet which did not include much protein (LPD). We see that the malnourished mice gained a lot less weight during their 4 weeks on the diet. After this the mice were allowed to recover for a while (4 weeks) where the weight gain between the two groups was similar (marked recovery in the plot). Finally the two mouse groupings were then given either normal food (chow) or the high fat high caloric (HFHC) diet. There are two groupings marked in the figure on the far right one with a (#, the normal diet group) and the other with a (§, the malnourished group). We can see that the mice fed the high fat high calorie diet gained more weight then the normal chow mice, but that there was no real difference between the malnourished and non malnourished mice.



Reproduced From [2] Figure 1B

Above we are looking at the total body weight of the mice, and we can see that the trend the previous data describes, holds here as well. Despite the initial malnourishment there is no real significant difference the body masses of the two groups of mice by the end of the study. The high fat high calorie fed mouse weight more (purple and green), and the normal chow mice weigh less (blue and red), irrespective of the initial treatment.


Reproduced From [2] Figure 2B and C

In addition to looking at body mass, the authors also examined metabolism through quantifying the amount of respiration (O2 consumption and CO2 production) of the animals. In the plot above "light" refers to the light cycle aka day time when the animals are asleep, and dark refers to the dark cycle aka night time when the animals are up and eating.

The authors observed no difference in the energy expenditure of the mice while they were being fed the normal or malnourished diets, however during the recovery phase some things changed. Above on the left we can see that the mice which were given the low protein malnourished diet had slower metabolic processes then did the mice which were fed the normal diets during their resting time (light cycle). This is carried over to the right, where the mice fed the malnourishing diet (LPD) did not display the increase in metabolism when fed the high fat high calorie diet (HFHC) that the mice who were not malnourished (NPD) display.

The authors also explored glucose sensitivity and found that during the recovery phase after the malnourished diet treatment, the malnourished mice had higher blood glucose levels then the normally fed mice. However this phenomenon corrected itself, and after the 16 week feeding period with the HFHC diet the difference in blood glucose levels between the mouse groupings disappeared. Indicating that the malnourished diet did temporarily result in an intolerance to glucose, but it was not permanent.

One of the other concerns is that a high fat high calorie diet can worsen the issues of fatty liver development that is common (as mentioned above) after people have been malnourished. However much like glucose sensitivity, the authors observed no statistically significant difference between the livers of the two mouse groupings.

Conclusions

Based on the model the authors constructed in the mice they conclude that exposure to a high fat, high calorie diet later in life after having been malnourished in early life does not make one more likely to develop diabetes (glucose sensitivity) or fatty liver disease later on in life. Granted this is only a mouse model, but the lack of observing any difference in this case can only be interpreted as a good thing.

You read this whole article, and in the end got to a non result! Do you feel like your time was wasted? You shouldn't because the positive result would be more unfortunate data and mean increased suffering for those who have already suffered so much due to being born in an area with little food.

Now if only we could get our collective asses in gear and try to help set up appropriate supply chains to better get food to those people who need it the most...

Extra Citation Information

  1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60937-X/fulltext
  2. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199916
  3. https://linkinghub.elsevier.com/retrieve/pii/S0026049512000479
  4. https://academic.oup.com/tropej/article/45/2/71/1710224
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This is a quite interesting study and it is, as you say, positive that at the end, there were not significant consequences to the mice. However, the malnutrition of these mice was only for 4 weeks, and it is well known that in acute malnutrition the principal parameter that gets affected it's weight and it can be reversed.

Sadly, in development countries the kids spend several months or even years, in malnutrition and not only the weight, but the height gets affected. They lack so many nutrients that also help to developt the brain, the inmune system, the hormones, among others, that the consequences are atrocious.

I'm in my last year of Medical School in Venezuela, and my thesis is about the comorbilities that kids with chronic malnutrition have, being one of the most common cause of hospitalization. Since they are inmunosuppressed, they are more susceptible to bacterial infections, parasitism and even virus like HIV.

These patients can receive all the antibiotics for their diseases, but if they don't get the necessary nutritients, their bodies won't be able to fight them.

This is our everyday in our hospital and is disheartening to see so many babies and young kids die because of this.

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Oops. Sad to read this.

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Thanks for bringing these issues to our attention. We do know of those problems, however they do seem to be better now than they were in the 1960's, according to the IMF data.
We are aware of the problems you are faced with there and we hope that we can help you overcome them as soon as your government allows that to happen. For now, we can only support you here.
Keep fighting!

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This is @hayleeng, the reality that we all live here in Venezuela, see so much pain. I was also doing my specialization in the University Clinical Hospital and see so much scarcity and need part of the soul.

From first-hand experience, I noticed that children from well-to-do families are usually taller than their counterparts which I think boils down to the diet/nutrition of them compared to the almost non-existent one of the poor families. Even when the poor family children later catch on in life and experience a better food/diet, their height never gets to that of the more affluent family's offspring. Of course, this was never an experiment carried out, just something I experienced which I guess may just be my mind playing tricks on me.

But are there any scientific explanation for this?

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A lack of nutrition during developmental times can result in stunted growth, so yeah people who eat better certainly could grow to be a bit taller on average.

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Not in my case and my brothers. I certainly eat on an average portion of the meal and with some diet that I followed constantly but still, I don't get the desired height. And it's totally opposite with my brothers, yet they are all taller than me and they smoke a lot. :(

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Thank you. That sucks for most families in the developing country such as ours.

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Is food expensive there? Or just unavailable altogether?

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Food is very expensive. One of the basic commodity here costs a lot. I live in Nigeria and trust me, you can use almost all your earnings on food. Its really very sad and demoralizing.

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The well-balanced diet food type is kind of expensive.

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What is expensive to you, can you define that for me?

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There's garri the high carbohydrates based staple food which is almost affordable by a lot of families. But most protein-rich food eg. meat, fish, etc are a bit more expensive that some families only get to have them once a week especially on Sundays.

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No no how much money is "expensive" is my question. Expensive to one area is not always so expensive to another. I'm curious what expensive means in your area.

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I guess you are a Nigerian too. Even Garri price is rising. I don't know where this country is moving. The cost of living is too high. As a student, you have to work part-time because your parents cant definitely cater for all your needs. This has led to increase in crime rates and diminished the reputation of our country

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Does this have something to do with the pursuit of cash crops impacting the availability of native crop diversity?

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No, the country is over dependent on fossil fuel exploration. So other things like agriculture are relegated to the background. In the '70s, agriculture was the mainstay of the country with us exporting a lot of cash crops like cocoa, groundnut, palm oil, etc. But the oil - black gold or curse (depending on who you ask) is like a virus that had spread and infected and crippled other sectors of the economy.

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That is quite unfortunate and ironic given the huge role fossil fuels play in modern agriculture at every step of the process.

I suppose the non result is why this paper is in PLOS one and not something with a higher impact factor. I imagine that they measured a whole bunch of other development indicators too, but are only reporting those that are worth mentioning.

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I'd suspect you are correct.

I would be concerned with a malnourished child's brain and organ development. I wonder if those are things as well that will catch up over time as the nutrition improves or are there important stages of growth that are being missed, which have long term negative effects.

It's sad once you know as well that we grow enough food on earth to feed every human being. Unfortunately, a large majority of that grain goes to feed livestock that can only be afforded by those not living in poverty.

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I wonder if those are things as well that will catch up over time as the nutrition improves or are there important stages of growth that are being missed, which have long term negative effects.

This is likely a multifaceted question and depends on the duration of malnurishment.

It's sad once you know as well that we grow enough food on earth to feed every human being.

Truly is.

Malnutrition is a very big issue especially in African countries. Different organisations are standing up for the cause but we still need more.

Lets eradicate poverty together in the world. It starts with you and everyone.

Food based in vitamins ia the most important for our body which se find it in fruits and vegetables

Hi @justtryme. Nice to meet you!. When I read the title and the beginning of your article, I identified myself because I have always had concerns about the future effect of malnutrition. However, it is great to know that there is no evidence of that. In my country for several years now, the majority of the population is undernourished, many are dying daily due to it, including children. Others do not die but what they are eating does not meet the adequate requirements, being the consumption almost entirely of flour, which is very very bad. Those of us who can collaborate are doing so, however, worrying about the effect on their organism and their cognitive development in those who since birth could not have the necessary nutrients. Thank you for your interest in the subject and the motivation to act!
God bless you.

Hello @justtryme90

I am certainly happy at the outcome of this study. And for sure, it isn't a waste of time reading this in the first place because the information gained is more important than anything else.

...exposure to a high fat, high calorie diet later in life after having been malnourished in early life does not make one more likely to develop diabetes (glucose sensitivity) or fatty liver disease later on in life.

I very much agree with this outcome because I can't imagine what would have happened to malnourished people if the reverse was to be the case as it is evident that majority of world's population from development countries may have suffered malnutrition at one point or the other.

Regards

@eurogee of @euronation and @steemstem communities

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I am certainly happy at the outcome of this study...I can't imagine what would have happened to malnourished people if the reverse was to be the case as it is evident that majority of world's population from development countries may have suffered malnutrition at one point or the other.

My thoughts exactly!

A non result is a result. This may save time to others to undertake a similar study, or maybe motivate some others to start a deeper study. I strongly believe non results, even if not exciting, should be published. They consist in information valuable in one way or the other.

images (1).jpegAvailable statistics indicates that over two billion people in the world suffer from various forms of malnutrition.
The term malnutrition addresses 3 broad groups of conditions: undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age).

Well, the conclusion was indeed heart-warming. And yes, greenrun is right, we've got more people in Nigeria who feed on staple produce like garri and rice everyday than on a well balanced diet. Growing up, I wasn't exactly from a rich home and there were times when we just had to make do with whatever we had, so, malnutrition.

I guess I was a bit scared of the outcome of this one. Glad that went well, phew!

But it isn't all final is it? I mean, It's mice, afterall.

Edit: reading some of the comments, it might just have long-term effects on humans since full development takes years to achieve that. For one, the brain. Sad.

Still, I'll check the reference materials.

Thank you so much for the generous upvote. Saw you're in Boston - Mike and I met there and I went to NESOP there to get a degree. Thank you again!

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You're welcome

like that topic will help to eradicate malnutrition by awareness

You have raised serious issues.
It is sad to realize that in the XXI century people live in starvation
Thank you for your wise thoughts and story
about the research on mice...
I hope that scientists will come up with
something to improve the lives of people in such regions.

I did not feel it a waste of time the article is very interesting. As you say malnutrition is a big issue. I live in South Africa and although we are better off than most other African countries, we still see poverty daily and a lot of people begging on the street corners, and one cannot help everybody, except for not having enough good food these people also sleep on the streets, it is really sad. (And then some of our politicians use the countries tax earnings to enrich themselves)
Thanks for sharing.

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I'm sick of see this things... why the rich people can't do nothing about it !

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Because they don't care. Which is sad.