Non-alcoholic fatty liver disease among adult survivors of severe acute malnutrition

OBJECTIVE: To investigate whether malnutrition survivors had more liver fat than controls and whether marasmus survivors (Ms) had more liver fat than kwashiorkor survivors (Ks). SUBJECTS AND METHODS: We traced 726 of 1336 adults admitted to hospital as infants with a diagnosis of severe acute malnutrition. We used birthweight (BW) from hospital records and measured anthropometry, body composition (DEXA) and liver fat using single, crosssectional computed tomography (CT) scanning at T12/L1 vertebrae. Data were analysed using multivariate line arregression. RESULTS: We studied 45 Ms, 43 Ks and 84 age-, gender and body mass index (BMI)-matched controls (age 29.0 ±8.4 years, BMI 23.5 ± 5.0 kg/m2). Using LS ratio, malnutrition survivors had less liver fat than controls (1.3± 0.2 vs 1.2 ± 0.9, p = 0.03). Marasmus survivors had lower BW than Ks (-0.51 kg; p = 0.02), were younger (p =0.02), had smaller waists (p = 0.03), were thinner (p =0.01) and had less body fat (p = 0.05) compared to Ks.Marasmus survivors had more liver fat than Ks after adjusting for age, gender and BW (â = -2.62, SE = 1.23; p= 0.03). Lower BW infants had less liver fat after adjusting for diagnosis (â = -1.51, SE = 0.76; p = 0.04). CONCLUSION: Fatty liver occurs at lower BMI in Ms compared with Ks; this difference is likely due to both prenatal and postnatal factors acting independently. While further studies are needed to understand the mechanisms involved, our data suggest the need to monitor infants exposed to severe acute malnutrition beyond the acute episode.

Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago

BACKGROUND: This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS: A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS: Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS: Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.