Changes in plasma citrulline concentration among young Malian children with moderate acute malnutrition following a 12‐week dietary intervention

Abstract

BackgroundThe amino acid citrulline (Cit) is a biomarker of enterocyte mass and may be useful in assessing intestinal absorptive capacity of undernourished children in developing countries.ObjectiveTo evaluate changes in plasma Cit in Malian children aged 6–35 months with non‐edematous, moderate acute malnutrition (MAM) before and after nutritional rehabilitation.MethodsPlasma Cit was measured using ultra performance liquid chromatography and mass spectrometry in 128 children (mean age 15.5 mo) enrolled in a trial that provided 500 kcal/d of supplementary food for 12 wks.ResultsAt baseline, the mean weight‐for‐height Z (WHZ), height‐for‐ age Z, mid‐upper arm circumference (MUAC), C‐reactive protein (CRP), and plasma Cit concentration were −2.22, −2.16, 12.1 cm, 7.7 mg/L and 12.3 μmol/L, respectively. At 12 wks, mean ± SD Cit increased to 14.3 ± 5.8 μmol/L (p<0.0001). Mean change in plasma Cit was greater among the 88 children who recovered from MAM vs. the 40 who did not (2.7 ± 5.2 μmol/L vs. 0.6 ± 4.8 μmol/L, p=0.03). After controlling for age, sex, baseline CRP and Cit, a 1 μmol/L increase in Cit was associated with increases of 0.037 in WHZ (p=0.005) and 0.029 in MUAC (p=0.04).ConclusionsCit increased with gains in WHZ and MUAC during nutritional rehabilitation and may reflect an improved ability to absorb essential nutrients.