Abstract
OBJECTIVES: Hepatic steatosis has been described in children with severe acute malnutrition, but the degree of liver damage in children with moderate acute malnutrition (MAM) is unknown. This study aimed to investigate the development of malnutrition-associated liver damage by describing liver function tests among children with MAM. METHODS: This study was a randomized 2 × 2 × 3 factorial trial, Treatfood, conducted in Burkina Faso. Children (6-23 months) with MAM received either a lipid-based nutrient supplement or a corn-soy blend, containing either dehulled soy or soy isolate and different quantities of dried skim milk. Malaria rapid diagnostic tests and liver function tests were performed at inclusion and after 3 months of supplementation and compared to Danish reference intervals. Associations were analyzed with linear regressions or tobit regressions, and odds ratios were calculated with logistic regressions, all age- and sex-adjusted. RESULTS: In total, 1405 children had one or more liver function tests measured at baseline. The median age was 11.4 months [interquartile range: 8.2-16.1]. Few children had elevated concentrations of liver function tests at baseline. Concentrations of total bilirubin were 19% (95% confidence interval: 2-40) greater among children with length-for-age Z-scores <-3 compared with children with Z-scores ≥-2. The concentrations of total bilirubin and alkaline phosphatase were negatively associated with age. Minor changes in the serum concentrations of liver function tests were observed after intervention. CONCLUSIONS: Liver function tests were largely within the normal range, whereby no signs of manifest liver damage were found. Children with stunted growth had higher bilirubin, which might indicate subclinical liver damage. CLINICAL TRIAL REGISTRATION: ISRCTN number: ISRCTN42569496.