Abstract
BackgroundMalnutrition continues to be a major cause of mortality and morbidity among children in resource limited settings. Children with severe acute malnutrition (SAM) experience severe thymus atrophy, possibly reflecting poor immune function. This immune dysfunction is responsible for the severe infections they experience which lead to mortality. Since their immune dysfunction is not fully understood and there has been a lapse in research in this field, more research is needed. Knowing the correlates of thymus size may help clinicians identify those with more severe atrophy who might have more severe immune impairment. We aimed to describe thymus size and its correlates at admission among children hospitalized with SAM.MethodsThis cross-sectional study involved children 6-59 months admitted with complicated SAM in Mulago National Referral Hospital. Well-nourished children from same communities were used as a community reference group for thymus size. At admission, thymus size was measured by ultrasound scan. Demographic, clinical and laboratory variables were identified at admission. A linear regression model was used to determine correlates of thymus size among children with SAM.ResultsAmong 388 children with SAM, the mean age was 17±8.5 months and 58% were boys. The mean thymus size was 3.14 (95% CI 2.9; 3.4) cm2 lower than that of the 27 healthy community reference children (1.06 vs 4.2 cm2, p<0.001) when controlled for age. Thymus size positively correlated with current breastfeeding (0.14, 95% CI 0.01, 0.26), anthropometric measurements at admission (weight, length, mid-upper-arm circumference, weight-for-height Z scores and length-for-age Z scores) and suspected tuberculosis (0.12, 95% CI 0.01; 0.22). Thymus size negatively correlated with > 2 weeks duration of sickness (-0.10; 95% CI -0.19; -0.01).ConclusionThe thymus is indeed a barometer for nutrition since all anthropometric measurements and breastfeeding were associated with bigger thymus. The immune benefits of breastfeeding among children with SAM is underscored. Children with longer duration of illness had a smaller thymus gland indicating that infections have a role in the cause or consequence of thymus atrophy.
Highlights
Malnutrition continues to be a major cause of mortality and morbidity among children in resource limited settings
Selection criteria We included children aged 6–59 months admitted with severe acute malnutrition (SAM) in Mwanamugimu Nutrition Unit (MNU) and whose caretakers consented to participate in the study
Oedematous SAM was present in 66% (N = 263) of the children with SAM (Table 2), and 11% (N = 43) were confirmed to be Human Immunodeficiency Virus (HIV) infected
Summary
Malnutrition continues to be a major cause of mortality and morbidity among children in resource limited settings. Children with severe acute malnutrition (SAM) experience severe thymus atrophy, possibly reflecting poor immune function. The high mortality rate among children hospitalized with severe acute malnutrition (SAM) is largely due to the high burden of infections they experience, with diarrhoea and pneumonia being the most common [2, 3]. This increased susceptibility to infection is not well understood but it is likely due to changes in immune functions associated with malnutrition [4]. This could be as a result of several micronutrient deficiencies [7, 9], hormonal changes [10, 11], lack of energy and building blocks [12] and concurrent infections [13]
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