Long-term health after Severe Acute Malnutrition in children and adults: the role of the Pancreas - SAMPA

Whilst there is an increasing prevalence of overweight and obesity worldwide, malnutrition remains common. In addition, malnutrition, overweight, and infections often interact. It is well established that malnutrition in pregnancy, resulting in an infant born with low birth weight, can increase the risk of diseases such as diabetes, heart disease and cancer in adulthood. However, the consequences of malnutrition after birth are much less studied. Severe acute malnutrition in childhood, indicated by extreme thinness, remains common in Africa and Asia. In addition, substantial numbers of adult patients with tuberculosis or HIV, diseases which are common in Africa and Asia, may become malnourished. We are interested in diabetes, which in Africa and Asia affects people at younger age and lower weight than in Europe. There is evidence from epidemiological studies that severe malnutrition in childhood and possibly in adulthood increases the risk of later diabetes but the evidence is piecemeal and there is little information as to the mechanisms involved. It is thus difficult to determine what treatments or preventative strategies are appropriate. We wish to focus on the pancreas which is a key organ in digestion and metabolic processes, especially in relation to diabetes. We will investigate pancreas size, microscopic structure, hormone and digestive enzyme production, and the body's response to these hormones among groups of people in Tanzania, Zambia, India and the Philippines. These groups have participated in the research team's previous studies of malnutrition and were malnourished before birth, as children, or as adults. They now live in places with a wide range of access to foods high in fat and sugar which could affect their risk of diabetes. We will use modern clinical methods to compare their pancreas function to that of never-malnourished controls at each site. We will use advanced statistical methods to understand the links between early malnutrition and later diabetes, taking into account the factors often associated with diabetes such as age, current overweight and infection. The project will have a substantial training component so that staff at all sites can be trained in assessment methods for nutritional status including body fat and lean content, diabetes, and pancreas function and in statistical methods. We will work with local clinicians and patient support groups to ensure that results of the project are taken up and used locally. We also plan to conduct workshops with the child participants to help them understand aspects of the science in which they are involved. Even if we find no important link between early malnutrition and later diabetes, the research will lead to improved understanding of the long-term consequences of malnutrition and the presentation and underlying metabolism of diabetes in Africa and Asia. Thus, the project will lead to improved health care for both malnourished and diabetic people.