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Food Nutr Bull. 2019 Jul 14:379572119853930. doi: 10.1177/0379572119853930. [Epub ahead of print]

Urinary Organic Acids Increase After Clinical Stabilization of Hospitalized Children With Severe Acute Malnutrition.

Author information

1
1 Hospital for Sick Children, Toronto, Canada.
2
2 Faculty of Medicine, University of Toronto, Toronto, Canada.
3
Allison I. Daniel and Matilda E. Arvidsson Kvissberg are co-first authors.
4
3 University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
5
4 College of Medicine, University of Malawi, Blantyre, Malawi.
6
5 The Childhood Acute Illness and Nutrition Network, Narobi, Kenya.
7
6 Academic Medical Centre, University of Amsterdam, The Netherlands.
8
7 University of Alberta, Edmonton, Canada.

Abstract

BACKGROUND:

Despite a reduction of child mortality in low-income countries, acutely ill undernourished children still have an elevated risk of death. Those at highest risk are children with severe acute malnutrition (SAM) who often show metabolic dysregulations that remains poorly understood.

OBJECTIVE:

We performed a pilot study to examine changes in urinary organic acids during nutritional rehabilitation of children with SAM, and to identify metabolites associated with the presence of edema or with mortality.

METHODS:

This study included 76 children aged between 6 and 60 months, hospitalized for SAM at the Moyo Nutritional Rehabilitation and Research Unit in Blantyre, Malawi. Urine was collected at admission and 3 days after clinical stabilization and metabolomics were performed using gas chromatography-mass spectrometry. Metabolite concentrations were evaluated with both uni- and multivariate approaches.

RESULTS:

Most metabolites increased 3 days after clinical stabilization, and total urinary concentration changed from 1.2 mM (interquartile range [IQR], 0.78-1.7) at admission to 3.8 mM (IQR, 2.1-6.6) after stabilization (P < .0001). In particular, 6 metabolites showed increases: 3-hydroxybutyric, 4-hydroxyhippuric, p-hydroxyphenylacetic, oxoglutaric, succinic, and lactic acids. Urinary creatinine was low at both time points, but levels did increase from 0.63 mM (IQR, 0.2-1.2) to 2.6 mM (IQR,1.6-4.4; P < .0001). No differences in urinary profiles were found between children who died versus those who survived, nor between children with severe wasting or edematous SAM.

CONCLUSIONS:

Total urinary metabolites and creatinine increase after stabilization and may reflect partial recovery of overall metabolism linked to refeeding. The use of urinary metabolites for risk assessment should be furthered explored.

TRIAL REGISTRATION:

TranSAM study (ISRCTN13916953).

KEYWORDS:

gas chromatography–mass spectrometry (GC-MS); nutrition; nutritional rehabilitation unit (NRU); severe acute malnutrition (SAM); urine metabolomics

PMID:
31303023
DOI:
10.1177/0379572119853930

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