The study shows that kids who are still inflamed after leaving the hospital grow slower because inflammation blocks the growth hormone/IGF‑1 system and bone metabolism. Inflammation also cuts weight gain directly, and a leaky gut (enteropathy) makes inflammation worse. So, keeping inflammation low helps the body use IGF‑1 for growth and recovery.

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.