Immune Recovery Following Severe Acute Malnutrition in Children: Evaluating the Relationship between Immunologic and Anthropometric Outcomes

Abstract

Acute malnutrition remains a major contributor to pediatric mortality, affecting millions of children globally, especially in low-resource settings. Advances in therapeutic feeding programs lead to high rates of initial anthropometric recovery, though relapse rates remain unacceptably high. Relapse after anthropometric recovery suggests that other biological factors, including possibly underlying immune deficits, may contribute to poor long-term outcomes. This was a prospective cohort study conducted in Aweil East, South Sudan, which leveraged an ongoing research platform evaluating post-treatment outcomes for children 6-47 months old who were diagnosed with severe acute malnutrition. Children had anthropometric assessments and dried blood spots (DBS) taken at five timepoints, and blood samples were assessed for four markers of adaptive immune function, specifically T-cell counts, B-cell counts, T-cell replication function (TRECs), and B-cell replication function (KRECs). Differences between groups were assessed using linear and logistic regression models adjusted for age and sex. Children treated for SAM had higher immune marker levels than healthy controls at all time points. We found that in children recovered from SAM, higher levels of T-cells, B-cells, TRECs, and KRECs persist through the discharge timepoint and through one-month and three-month follow up. The specific immune markers explored here were not significant predictors of anthropometric recovery, suggesting that even those who have met criteria for discharge still have underlying immune dysregulation and ongoing inflammation.