Le syndrome métabolique

Risk of Chronic Disease after an Episode of Marasmus, Kwashiorkor or Mixed-Type Severe Acute Malnutrition in the Democratic Republic of Congo: The Lwiro Follow-Up Study

Background: Long-term impact of different forms of severe acute malnutrition (SAM) in childhood on the emergence of noncommunicable diseases (NCDs) is poorly known. Aim: To explore the association between subtypes of SAM during childhood, NCDs, and cardiovascular risk factors (CVRFs) in young adults 11 to 30 years after post-SAM nutritional rehabilitation. Methods: In this follow-up study, we investigated 524 adults (mean age 22 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Among them, 142 had a history of marasmus, 175 of kwashiorkor, and 207 had mixed-form SAM. These participants were compared to 407 aged- and sex-matched control adults living in the same community without a history of SAM. Our outcomes of interest were cardiometabolic risk markers for NCDs. Logistic and linear regressions models were sued to estimate the association between subtype of SAM in childhood and risk of NCDs. Results: Compared to unexposed, former mixed-type SAM participants had a higher adjusted ORs of metabolic syndrome [2.68 (1.18; 8.07)], central obesity [1.89 (1.11; 3.21)] and low HDL-C (High-density lipoprotein cholesterol) [1.52 (1.08; 2.62)]. However, there was no difference between groups in terms of diabetes, high blood pressure, elevated LDL-C (low-density lipoprotein cholesterol) and hyper TG (hypertriglyceridemia) and overweightness. Former mixed-type SAM participants had higher mean fasting glucose [3.38 mg/dL (0.92; 7.7)], reduced muscle strength [−3.47 kg (−5.82; −1.11)] and smaller hip circumference [−2.27 cm (−4.24; −0.31)] compared to non-exposed. Regardless of subtypes, SAM-exposed participants had higher HbA1c than unexposed (p < 0.001). Those with a history of kwashiorkor had cardiometabolic and nutritional parameters almost superimposable to those of unexposed. Conclusion: The association between childhood SAM, prevalence of NCDs and their CVRFs in adulthood varies according to SAM subtypes, those with mixed form being most at risk. Multicenter studies on larger cohorts of older participants are needed to elucidate the impact of SAM subtypes on NCDs risk.

[Physical activity in preventing metabolic syndrome in children]

Metabolic syndrome defined as the joint manifestation on the same subject of several risk factors (at least 3 in the majority of definitions) within the following parameters : hypertriglyceridemia, hypertension, abdominal obesity, low concentration of HDL-Cholesterol (HDL-C), and high fasting blood glucose is increasingly reported in children, mainly in the presence of overweight/obesity. In fact, up to 50 % of overweight/obese children can be affected by this syndrome. Furthermore, the metabolic syndrome acquired during childhood has been shown to impact highly into adulthood including by its clinical complications such as type 2 diabetes or cardiovascular diseases. Among the practical preventive and therapeutic measures to be taken in children, physical activity appears to be an option of choice. This review indicates that physical activity programs based either on aerobic exercise, resistance training, or a combination of these 2 types of activity may promote insulin sensibility and weaken or suppress the metabolic syndrome of children. More interestingly, usual physical activity including free-living activities of an intensity equivalent to a brisk walking should be encouraged earlier among children for its positive influence on parameters involved in the metabolic syndrome.