Association between Severe Acute Malnutrition during Childhood and Variability in Blood Pressure during Adulthood in Low- and Middle-income Countries: The Lwiro Cohort Study in the Democratic Republic of the Congo

Abstract Introduction: Little is known about the long-term outcomes of Severe Acute Malnutrition (SAM) during childhood. As such, this study aims to explore the association between childhood SAM and blood pressure (BP) variability in adulthood in a context without nutrition transition. Methodology: We identified 524 adults (Median age: 22 years) who were treated for SAM during childhood in Eastern DRC between 1988 and 2007. They were compared with 407 community unexposed age-and-sex matched with no history of SAM. The variables examined for this study were the systolic (SBP), diastolic (DBP), mean (MBP) and pulse (PP) blood pressures, as well as high blood pressure (HBP) in adulthood. For comparison, linear and logistic regression models were used for analysing continuous and dichotomous variables, respectively. Results: Of the 524 exposed located, 145 exposed were selected according to age. A total of 97 unexposed were recruited. Compared to unexposed, exposed had slightly higher SBP and PP after adjusting [SBP = 1.4 mm Hg (-2.2, 4.8) and PP = 2.6 mm Hg (-0.3, 6.0)]. However, their mean DBP was lower that of among the unexposed [ -1.6 mm Hg (-4.6, 1.5)]. MBP and creatinine levels were comparable between the two groups. The prevalence of HBP adjusted for age was higher among exposed than unexposed (9.7% vs 5.3%). In addition, the odds of having HBP was higher among exposed than unexposed, however the difference was not statistically significant [ORa 1.9 (0.7, 5.6)]. Finally, using multiple regression, although the effect was not significant, SAM was a major contributor to HBP [OR 3.1 (0.9,10.9), p = 0.064], while being male and higher BMI were the only independent predictors among the young population of this study. Conclusions: There was no significant impact from an episode of SAM during childhood on BP variability in young adults in a context without nutrition transition. However, people who experienced a period of SAM had a higher prevalence of HBP and a much higher risk of developing HBP than unexposed. Additional multicentre studies involving a larger cohort would provide greater understanding of the impact of SAM on the overall risk of BP disorders during adulthood.