Fig. 6. Proposed pathways underlying mortality of CSM.

Mortality in children with CSM can be attributed to the interplay between mitochondrial dysfunction and systemic inflammation. Severe malnutrition leads to defective mitochondrial energy metabolism, which increases individual’s susceptibility to impaired immune response against infections leading to sepsis-like systemic inflammation. Increased systemic inflammation, in turn, amplifies bioenergetic inefficiency. The interplay between bioenergetic failure and exacerbated inflammation can cause tissue and organ damages and ultimately lead to death.