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

Childhood growth can be affected by acute illness, chronic conditions, diet and their home environment. In resource-poor settings, children often experience poor growth following illness, but the mechanisms are poorly understood. This cohort study nested within the CHAIN cohort in six countries in sub-Saharan Africa and south Asia investigated pathways linking inflammation and post-discharge weight gain among children hospitalised with acute illness. We analysed biomarkers of inflammation, enteropathy, growth mediators and other exposures at hospital discharge and examined how they impact post-discharge weight gain during 90 days. Linear mixed models determined associations between exposures and weight gain while structural equation models explained how these exposures influence growth. We show that systemic inflammation impacts mediators of linear growth including the GH/IGF1 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. Intestinal dysfunction impacts growth through systemic inflammation. Adverse household and chronic medical conditions predominantly influenced weight gain through inflammation. Persistent systemic inflammation at hospital discharge strongly impairs post-discharge linear growth and limits weight gain. It is critical to address inflammation, the intestinal mucosal barrier and other exposures driving inflammation to optimise recovery. One Sentence Summary: Inflammation driven by illness, enteropathy and adverse social factors redirects post-hospital recovery away from linear growth and limits weight gain.