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

ABSTRACT

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.