Dixi Paglinawan Modoc, Sana Ahmed, Molly Chisenga, Sharon E Cox, Riddhi Dasgupta, Paulita Duazo, Daniel Faurholt-Jepsen, Lackson Kasonka, Paul Kelly, Ruth Keogh, Belinda Kweka, Rikke Krogh-Madsen, Nanette Lee, Evangelista Malindisa, Dorothea Nitsch, Patrick Ngoya, George PrayGod, James AM Shaw, Juan Antonio Solon, Mizinga Jacqueline Tembo, Geeta Trilok-Kumar, Suzanne Filteau
Background: Prenatal or infant wasting malnutrition followed by later overweight is associated with increased risk of chronic diseases, including type 2 diabetes. Objectives: In a pooled analysis of 6 longitudinal cohorts, we investigated associations between prior malnutrition (PM) early in life or in adulthood and subsequent glycemic status. Methods: We identified cohorts in Tanzania, Zambia, India, and the Philippines in whom low birth weight or wasting malnutrition in childhood or as adults following human immunodeficiency virus or tuberculosis infection had been measured. Anthropometry, body composition, and glycemic status, determined by hemoglobin A1c (HbA1c), and glucose at 120 min in an oral glucose tolerance test (glucose120), were assessed 3–38 y after PM and in non-PM (NPM) controls. HbA1c and glucose120 were compared between PM and NPM participants by linear regression, controlling for age, sex, and socioeconomic status and, in pooled analyses, for cohort also. Results: In the full cohort of 2251 participants, there was no overall association between PM and diabetes risk. Child participants aged ∼12 y who were hospitalized with PM when <2 y had higher glucose120 compared to NPM (difference 0.50 mmol/L; 95% CI: 0.10, 0.91 mmol/L). In pooled analyses across adult cohorts controlling for cohort, age, sex, and socioeconomic status, PM participants, compared to NPM, may have higher glucose120 (difference 0.33 mmol/L; 95% CI: –0.27, 0.92 mmol/L) if still underweight, and higher HbA1c (difference 0.41%; 95% CI: –0.07%, 0.89%) and glucose120 (difference 0.70 mmol/L; 95% CI: –0.25, 1.66 mmol/L) if currently obese. Conclusions: Childhood PM is associated with greater adult dysglycemia, whereas adulthood PM may have heterogeneous outcomes dependent on subsequent presence/absence of weight gain. Clinicians and public health managers should be aware of the long-term risk and intervene to promote some weight gain but prevent excess weight gain in people who were previously malnourished. © 2025 The Author(s)
Nutrition Center of the Philippines, Manila, Philippines; Institute of Home Economics, University of Delhi, New Delhi, India; University Teaching Hospital, Lusaka, Zambia; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; University of San Carlos-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu, Philippines; Department of Infectious Diseases, Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Denmark; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Tropical Gastroenterology and Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia; Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania; Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Physiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Radiology, Bugando Medical Centre, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Trivedi School of Biosciences, Ashoka University, Haryana, India; Newcastle Centre for Diabetes Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
