Immune responses to topical emollient therapy with sunflower seed oil in young children with severe acute malnutrition in Bangladesh: a randomized controlled trial

Abstract

Background: Severe acute malnutrition (SAM) is associated with immune dysregulation and increased infection risk. Nutritional rehabilitation is essential for recovery; adjunctive topical therapy with sunflower seed oil (SSO) has shown benefits in improving skin barrier function and reducing infection risk. This study investigates the impact of emollient therapy on systemic immune responses in young children with SAM. Methods: A nested study within a randomized controlled trial was conducted among 212 Bangladeshi children aged 2–24 months with SAM. Participants received standard acute nutritional rehabilitation alone or along with adjunctive SSO therapy. Serum cytokine levels were measured at baseline and after 10 days of treatment. Statistical analysis using general linear regression assessed treatment effects on cytokine changes. Results: Cytokine levels were generally low, with no clinically relevant differences in IL-8, IL-10, or TNF-α levels between treatment groups. A decreasing trend in IL-8 coincided with weight gain, suggesting a potential inverse relationship between inflammation and nutritional recovery. Conclusions: While emollient therapy improved skin barrier function and reduced infection risk, its effects appear to be mediated through local cutaneous rather than systemic immune modulation. Further research is needed to explore impacts of emollient therapy on local and systemic immunological effects in malnourished children. Impact: This is the first study to investigate whether topical therapy with sunflower seed oil (SSO) influences systemic immune responses in children with severe acute malnutrition (SAM) undergoing standard acute nutritional rehabilitation. We found no significant changes in systemic cytokine levels attributable to 10 days of SSO treatment. Previous studies have shown that emollient therapy improves skin barrier integrity and function and reduces infection risk; this study underscores the need for further research (e.g., larger samples size, longer duration of treatment) into the immune response in malnourished children and how interventions like nutritional rehabilitation and emollient therapy interact with systemic inflammation.