Brain Volumetric Changes in Severely Malnourished Children: A Case-Control Magnetic Resonance Imaging Study.

Background: Severe malnutrition in early childhood may alter brain structure; quantitative Magnetic Resonance Imaging (MRI) data in this age group remain limited. This study aimed to assess brain volume and structural changes in severely malnourished children using brain MRI, for early detection and better management to improve quality of life. Methods: A case–control study included 24 children with severe malnutrition as cases and 24 healthy controls (all aged 1 month–5 years). All underwent history, systemic and neurological examination, and general examination including anthropometric measurements. Brain MRI included routine sequences plus 3D T1 for automated volumetry using VolBrain. Results: The cases group had significantly lower anthropometric indices, including BMI, weight, MUAC (all p<0.001), height (p=0.017), and Z-scores for growth measures (all p<0.001); Z score of head-circumference-for-age was reduced (p=0.017) with borderline head circumference difference (p=0.053). Volumetry showed reduced volume of brain (p=0.038), grey matter (p=0.036), cerebrum (p=0.038), cerebellum (p=0.046), hippocampus (p=0.014), amygdala (p=0.007), and frontal, parietal, and temporal lobes (p=0.035–0.043), with higher 4th-ventricle percentage (p=0.008). Age correlated positively with most brain volumes but negatively with caudate percentage and lateral-ventricle percentage (p≤0.05). Females had higher caudate percentage (p=0.011) and thalamus percentage (p=0.045). Head circumference and other anthropometric measures correlated positively with global and regional brain volumes (p≤0.001) and negatively with CSF and ventricular measures (p<0.05). Weight-for-height Z-score correlated positively only with hippocampal volume (r=0.325, p=0.024). Conclusion: Severe malnutrition in children is associated with marked reductions in global and regional brain volumes and with increased 4Th ventricle size.