Severe acute malnutrition is present in significant amounts in third world countries. Mortality rates are high because of a lack of understanding on how to treat and refeed patients. A new study found that diarrhea, low short-chain fatty acids and inflammation were associated with mortality, which could give clinicians insight as to how to better treat this condition.


Although food availability is rarely thought of in the Western world, food shortages are not irregular in other countries. Increased poverty in third world nations can lead to malnutrition, and in severe cases, a condition called severe acute malnutrition (SAM) can arise. In fact, an estimated 20 million children are suffering from SAM at any time.

SAM is characterized by very low weight, visible loss of fat and muscle tissue and edema. Most cases of SAM occur in Africa, but it is also present in areas of drought, famine or natural disasters. The condition is treatable, but mortality rates remain up to 30% in hospital, and higher if treatment cannot be acquired due to a lack of resources. Greater knowledge of its mechanisms could allow researchers to develop more effective treatment for SAM.

The research group of Attia et al. set out to discover more about SAM in their study published in the American Journal of Clinical Nutrition. They investigated the relationships between diarrhea, inflammation, fecal short-chain fatty acids (SCFAs) and intestinal pathogens. 79 children were drawn from a previous randomized clinical trial comparing outcomes of different rehabilitation diets. Intestinal pathogens, calprotectin (a marker of intestinal inflammation) and SCFAs were taken from stool samples, and cytokines (a marker of system inflammation) were taken from blood samples. Primary outcomes of the study were diarrhea and death.

The study found that mortality is correlated with diarrhea, systemic inflammation, intestinal inflammation and low levels of SCFAs. However, intestinal pathogens were highly variable among children with SAM and did not provide a significant association with mortality. SCFAs are significant due to their role in modulating metabolism and inflammation. Thus SCFA replenishment could be a focus of future treatments. Similarly, the finding of inflammation’s association with SAM-related mortality could lead to the use of anti-inflammatory agent supplementation in SAM treatment. The study was limited by sample size and future studies could include relations to variables such as HIV, phenotype and metabolic disturbances.

In summary, researchers found that mortality in SAM is associated with diarrhea, systemic and intestinal inflammation, and low SCFA levels. This information could be used to alter future treatment and refeeding strategies to improve patient mortality.


Written By: Wesley Tin, BMSc

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