Inflammation impairs post-hospital discharge growth among children hospitalised with acute illness in sub-Saharan Africa and south Asia

James M. Njunge (), Evans O. Mudibo, Jasper Bogaert, Benedict Orindi, Charles J. Sande, Celine Bourdon, Caroline Tigoi, Moses M. Ngari, Narshion Ngao, Elisha Omer, Wilson Gumbi, Robert Musyimi, Molline Timbwa, Shalton Mwaringa, Agnes Gwela, Johnstone Thitiri, Ezekiel Mupere, Christina L. Lancioni, Gerard Bryan Gonzales, Benson O. Singa, Emmie Mbale, Wieger P. Voskuijl, Donna M. Denno, Abdoulaye Hama Diallo, Roseline Maϊmouna Bamouni, Mohammod Jobayer Chisti, Abu Sadat Mohammad Sayeem Bin Shahid, Tahmeed Ahmed, Ali Faisal Saleem, Syed Asad Ali, Holm H. Uhlig, Kirkby D. Tickell, Robert H. J. Bandsma, Judd L. Walson and James A. Berkley
Additional contact information
James M. Njunge: The Childhood Acute Illness and Nutrition Network
Evans O. Mudibo: The Childhood Acute Illness and Nutrition Network
Jasper Bogaert: Ghent University, Department of Data Analysis, Faculty of Psychology and Educational Sciences
Benedict Orindi: KEMRI-Wellcome Trust Research Programme
Charles J. Sande: KEMRI-Wellcome Trust Research Programme
Celine Bourdon: The Hospital for Sick Children, Centre for Global Child Health
Caroline Tigoi: The Childhood Acute Illness and Nutrition Network
Moses M. Ngari: The Childhood Acute Illness and Nutrition Network
Narshion Ngao: The Childhood Acute Illness and Nutrition Network
Elisha Omer: The Childhood Acute Illness and Nutrition Network
Wilson Gumbi: The Childhood Acute Illness and Nutrition Network
Robert Musyimi: The Childhood Acute Illness and Nutrition Network
Molline Timbwa: The Childhood Acute Illness and Nutrition Network
Shalton Mwaringa: The Childhood Acute Illness and Nutrition Network
Agnes Gwela: The Childhood Acute Illness and Nutrition Network
Johnstone Thitiri: The Childhood Acute Illness and Nutrition Network
Ezekiel Mupere: Makerere University College of Health Sciences, Department of Paediatrics and Child Health
Christina L. Lancioni: Oregon Health and Science University, Department of Paediatrics
Gerard Bryan Gonzales: Wageningen University and Research, Division of Human Nutrition and Health
Benson O. Singa: The Childhood Acute Illness and Nutrition Network
Emmie Mbale: The Childhood Acute Illness and Nutrition Network
Wieger P. Voskuijl: The Childhood Acute Illness and Nutrition Network
Donna M. Denno: University of Washington, Department of Paediatrics
Abdoulaye Hama Diallo: The Childhood Acute Illness and Nutrition Network
Roseline Maϊmouna Bamouni: The Childhood Acute Illness and Nutrition Network
Mohammod Jobayer Chisti: The Childhood Acute Illness and Nutrition Network
Abu Sadat Mohammad Sayeem Bin Shahid: The Childhood Acute Illness and Nutrition Network
Tahmeed Ahmed: The Childhood Acute Illness and Nutrition Network
Ali Faisal Saleem: The Childhood Acute Illness and Nutrition Network
Syed Asad Ali: The Childhood Acute Illness and Nutrition Network
Holm H. Uhlig: University of Oxford, Translational Gastroenterology Unit, John Radcliffe Hospital
Kirkby D. Tickell: The Childhood Acute Illness and Nutrition Network
Robert H. J. Bandsma: The Childhood Acute Illness and Nutrition Network
Judd L. Walson: The Childhood Acute Illness and Nutrition Network
James A. Berkley: The Childhood Acute Illness and Nutrition Network

Nature Communications, 2025, vol. 16, issue 1, 1-14

Abstract: Abstract In resource-limited settings, children often experience poor growth following illness, but the mechanisms are poorly understood. This cohort study in six countries in sub-Saharan Africa and south Asia investigates pathways linking inflammation and post-discharge weight gain among children hospitalised with acute illness. We determine associations between inflammation, enteropathy, growth mediators and other exposures at hospital discharge and weight gain during 90 days and explain how these exposures influence growth. Here, we show that systemic inflammation impacts mediators of linear growth including the Growth hormone/Insulin-like growth factor 1 axis and bone metabolism to a larger extent and weight gain via enteroendocrine peptide YY and glucagon pathways to a lesser extent. Systemic inflammation negatively affects weight gain directly. Enteropathy impacts growth through systemic inflammation. Adverse household and chronic medical conditions predominantly influence weight gain through inflammation. It is critical to address inflammation, the intestinal mucosal barrier and other exposures driving inflammation to optimise recovery.

Date: 2025
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DOI: 10.1038/s41467-025-66245-2

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