Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal
Early childhood growth retardation persists in developing countries despite decades of nutritional interventions. Adequate food is necessary, but not sufficient, to ensure normal growth where there is ubiquitous exposure to infection. Pathways associated with infection, small intestinal mucosal dama...
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| Veröffentlicht in: | British journal of nutrition 2009-02, Vol.101 (4), p.558-567 |
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| creator | Panter-Brick, Catherine Lunn, Peter G. Langford, Rebecca M. Maharjan, Makhan Manandhar, Dharma S. |
| description | Early childhood growth retardation persists in developing countries despite decades of nutritional interventions. Adequate food is necessary, but not sufficient, to ensure normal growth where there is ubiquitous exposure to infection. Pathways associated with infection, small intestinal mucosal damage and chronic immunostimulation remain largely undemonstrated in countries other than The Gambia. We conducted a longitudinal study of one squatter and one middle-class group (n 86, 3–18 month olds) to assess these relationships in Nepal. Growth, mucosal damage index (MDI; urinary lactose:creatinine ratio adjusted for body weight), morbidity reports, and blood concentrations of albumin, α-1-acid glycoprotein, IgG and Hb, were recorded monthly. Growth status worsened dramatically from 6 to 18 months, with squatters more stunted (height-for-age Z-score (HAZ), P |
| doi_str_mv | 10.1017/S000711450802744X |
| format | Article |
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Adequate food is necessary, but not sufficient, to ensure normal growth where there is ubiquitous exposure to infection. Pathways associated with infection, small intestinal mucosal damage and chronic immunostimulation remain largely undemonstrated in countries other than The Gambia. We conducted a longitudinal study of one squatter and one middle-class group (n 86, 3–18 month olds) to assess these relationships in Nepal. Growth, mucosal damage index (MDI; urinary lactose:creatinine ratio adjusted for body weight), morbidity reports, and blood concentrations of albumin, α-1-acid glycoprotein, IgG and Hb, were recorded monthly. Growth status worsened dramatically from 6 to 18 months, with squatters more stunted (height-for-age Z-score (HAZ), P < 0·001) and underweight (weight-for-age Z-score (WAZ), P = 0·009) than middle class. IgG increased with age, was elevated in squatter children, and negatively related to WAZ (P = 0·034). MDI showed significant negative associations with growth performance, explaining 9 and 19 % of height and weight deficits (ΔHAZ, P = 0·004; ΔWAZ, P < 0·001). Unexpectedly, these associations were weaker in squatter children, namely in the group which showed poorer growth, elevated morbidity, greater pathogen exposure (IgG) and higher MDI (P < 0·001). In Nepal, as in The Gambia, children exhibit poor growth, mucosal damage and immunostimulation. The relative impact of pathways associated with infection and undernutrition may, however, differ across socio-economic groups: in poorer children, the impact of mucosal damage and immunostimulation could be masked by nutritional constraints. This has important implications for public health interventions.</description><identifier>ISSN: 0007-1145</identifier><identifier>EISSN: 1475-2662</identifier><identifier>DOI: 10.1017/S000711450802744X</identifier><identifier>PMID: 18662426</identifier><identifier>CODEN: BJNUAV</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Age ; albumins ; alpha-1-acid glycoprotein ; animal injuries ; Bacterial Infections - immunology ; Bacterial Infections - physiopathology ; Biological and medical sciences ; blood proteins ; Body Height ; Body Weight ; Breast Feeding ; Case-Control Studies ; Creatinine ; Developing Countries ; Economics ; Feeding. Feeding behavior ; Fundamental and applied biological sciences. Psychology ; glycoproteins ; Growth Disorders - etiology ; Growth Disorders - immunology ; Growth Disorders - physiopathology ; growth retardation ; Health promotion ; height ; hemoglobin ; Human and Clinical Nutrition ; Humans ; Immune response ; immunoglobulin G ; Infant ; infant development ; Infant growth ; infant nutrition ; Infant Nutritional Physiological Phenomena ; Infant, Newborn ; infants ; intestinal mucosa ; Intestinal Mucosa - immunology ; Intestinal Mucosa - microbiology ; Intestinal Mucosa - pathology ; Intestinal permeability ; Intestine, Small ; Lactose ; LDCs ; Longitudinal studies ; Malnutrition ; Maternal & child health ; Middle class ; Morbidity ; Nepal ; Nutritional Status ; Permeability ; Poverty ; Public health ; Public health policy ; Small intestine ; socioeconomic status ; Socioeconomics ; Squatters ; The Gambia ; underweight ; Urine ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Weaning</subject><ispartof>British journal of nutrition, 2009-02, Vol.101 (4), p.558-567</ispartof><rights>Copyright © The Authors 2008</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-8e216c253601a8881720ff8543a10deedd67e115a3ae3ad34cf1b132069e3b813</citedby><cites>FETCH-LOGICAL-c536t-8e216c253601a8881720ff8543a10deedd67e115a3ae3ad34cf1b132069e3b813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S000711450802744X/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,780,784,27924,27925,55628</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21148916$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18662426$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Panter-Brick, Catherine</creatorcontrib><creatorcontrib>Lunn, Peter G.</creatorcontrib><creatorcontrib>Langford, Rebecca M.</creatorcontrib><creatorcontrib>Maharjan, Makhan</creatorcontrib><creatorcontrib>Manandhar, Dharma S.</creatorcontrib><title>Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal</title><title>British journal of nutrition</title><addtitle>Br J Nutr</addtitle><description>Early childhood growth retardation persists in developing countries despite decades of nutritional interventions. Adequate food is necessary, but not sufficient, to ensure normal growth where there is ubiquitous exposure to infection. Pathways associated with infection, small intestinal mucosal damage and chronic immunostimulation remain largely undemonstrated in countries other than The Gambia. We conducted a longitudinal study of one squatter and one middle-class group (n 86, 3–18 month olds) to assess these relationships in Nepal. Growth, mucosal damage index (MDI; urinary lactose:creatinine ratio adjusted for body weight), morbidity reports, and blood concentrations of albumin, α-1-acid glycoprotein, IgG and Hb, were recorded monthly. Growth status worsened dramatically from 6 to 18 months, with squatters more stunted (height-for-age Z-score (HAZ), P < 0·001) and underweight (weight-for-age Z-score (WAZ), P = 0·009) than middle class. IgG increased with age, was elevated in squatter children, and negatively related to WAZ (P = 0·034). MDI showed significant negative associations with growth performance, explaining 9 and 19 % of height and weight deficits (ΔHAZ, P = 0·004; ΔWAZ, P < 0·001). Unexpectedly, these associations were weaker in squatter children, namely in the group which showed poorer growth, elevated morbidity, greater pathogen exposure (IgG) and higher MDI (P < 0·001). In Nepal, as in The Gambia, children exhibit poor growth, mucosal damage and immunostimulation. The relative impact of pathways associated with infection and undernutrition may, however, differ across socio-economic groups: in poorer children, the impact of mucosal damage and immunostimulation could be masked by nutritional constraints. This has important implications for public health interventions.</description><subject>Age</subject><subject>albumins</subject><subject>alpha-1-acid glycoprotein</subject><subject>animal injuries</subject><subject>Bacterial Infections - immunology</subject><subject>Bacterial Infections - physiopathology</subject><subject>Biological and medical sciences</subject><subject>blood proteins</subject><subject>Body Height</subject><subject>Body Weight</subject><subject>Breast Feeding</subject><subject>Case-Control Studies</subject><subject>Creatinine</subject><subject>Developing Countries</subject><subject>Economics</subject><subject>Feeding. Feeding behavior</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>glycoproteins</subject><subject>Growth Disorders - etiology</subject><subject>Growth Disorders - immunology</subject><subject>Growth Disorders - physiopathology</subject><subject>growth retardation</subject><subject>Health promotion</subject><subject>height</subject><subject>hemoglobin</subject><subject>Human and Clinical Nutrition</subject><subject>Humans</subject><subject>Immune response</subject><subject>immunoglobulin G</subject><subject>Infant</subject><subject>infant development</subject><subject>Infant growth</subject><subject>infant nutrition</subject><subject>Infant Nutritional Physiological Phenomena</subject><subject>Infant, Newborn</subject><subject>infants</subject><subject>intestinal mucosa</subject><subject>Intestinal Mucosa - immunology</subject><subject>Intestinal Mucosa - microbiology</subject><subject>Intestinal Mucosa - pathology</subject><subject>Intestinal permeability</subject><subject>Intestine, Small</subject><subject>Lactose</subject><subject>LDCs</subject><subject>Longitudinal studies</subject><subject>Malnutrition</subject><subject>Maternal & child health</subject><subject>Middle class</subject><subject>Morbidity</subject><subject>Nepal</subject><subject>Nutritional Status</subject><subject>Permeability</subject><subject>Poverty</subject><subject>Public health</subject><subject>Public health policy</subject><subject>Small intestine</subject><subject>socioeconomic status</subject><subject>Socioeconomics</subject><subject>Squatters</subject><subject>The Gambia</subject><subject>underweight</subject><subject>Urine</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Weaning</subject><issn>0007-1145</issn><issn>1475-2662</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUFv1DAQhSMEotvCD-ACFhLcAh47cRxuqKIFqRSqthLiYs0mk6xLEi920rL_hx-Ko11aCYQ42aP3vWc_TZI8Af4KOBSvzznnBUCWc81FkWVf7iULyIo8FUqJ-8liltNZ30v2Q7iKowZePkz2QEcgE2qR_PyM4-oGN4F1hLUdWjY6Rui7DWu9uxlXrMFuJB-VNwwHZodrCqNtcbRuniI9rojZfu38iENFzDWsnyoXsGM19thStNUR6KfBRWc_db-9rLZNQ56GkQVXWZdS5QbX22p-elqHGTmlNXaPkgfxF4Ee786D5PLo3cXh-_Tk0_GHw7cnaZVLNaaaBKhKxDsH1FpDIXjT6DyTCLwmqmtVEECOEkliLbOqgSVIwVVJcqlBHiQvt7lr775Psafpbaio63AgNwWjVMlznfH_goJnXBW8jODzP8ArN_khljACpJYCMh0h2EKVdyF4asza2x79xgA386LNX4uOnqe74GnZU33n2G02Ai92AIYKu8bH5dhwy4mYpkuYuXTL2TDSj1sd_TejClnkRh2fmdMyO4KvZx_NReSfbfkGncHWx8zLc8FB8hgmci4jIXd1sF96W7d0V_rfhX4BgJ7aFQ</recordid><startdate>20090228</startdate><enddate>20090228</enddate><creator>Panter-Brick, Catherine</creator><creator>Lunn, Peter G.</creator><creator>Langford, Rebecca M.</creator><creator>Maharjan, Makhan</creator><creator>Manandhar, Dharma S.</creator><general>Cambridge University Press</general><scope>FBQ</scope><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20090228</creationdate><title>Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal</title><author>Panter-Brick, Catherine ; Lunn, Peter G. ; Langford, Rebecca M. ; Maharjan, Makhan ; Manandhar, Dharma S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c536t-8e216c253601a8881720ff8543a10deedd67e115a3ae3ad34cf1b132069e3b813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Age</topic><topic>albumins</topic><topic>alpha-1-acid glycoprotein</topic><topic>animal injuries</topic><topic>Bacterial Infections - immunology</topic><topic>Bacterial Infections - physiopathology</topic><topic>Biological and medical sciences</topic><topic>blood proteins</topic><topic>Body Height</topic><topic>Body Weight</topic><topic>Breast Feeding</topic><topic>Case-Control Studies</topic><topic>Creatinine</topic><topic>Developing Countries</topic><topic>Economics</topic><topic>Feeding. Feeding behavior</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>glycoproteins</topic><topic>Growth Disorders - etiology</topic><topic>Growth Disorders - immunology</topic><topic>Growth Disorders - physiopathology</topic><topic>growth retardation</topic><topic>Health promotion</topic><topic>height</topic><topic>hemoglobin</topic><topic>Human and Clinical Nutrition</topic><topic>Humans</topic><topic>Immune response</topic><topic>immunoglobulin G</topic><topic>Infant</topic><topic>infant development</topic><topic>Infant growth</topic><topic>infant nutrition</topic><topic>Infant Nutritional Physiological Phenomena</topic><topic>Infant, Newborn</topic><topic>infants</topic><topic>intestinal mucosa</topic><topic>Intestinal Mucosa - immunology</topic><topic>Intestinal Mucosa - microbiology</topic><topic>Intestinal Mucosa - pathology</topic><topic>Intestinal permeability</topic><topic>Intestine, Small</topic><topic>Lactose</topic><topic>LDCs</topic><topic>Longitudinal studies</topic><topic>Malnutrition</topic><topic>Maternal & child health</topic><topic>Middle class</topic><topic>Morbidity</topic><topic>Nepal</topic><topic>Nutritional Status</topic><topic>Permeability</topic><topic>Poverty</topic><topic>Public health</topic><topic>Public health policy</topic><topic>Small intestine</topic><topic>socioeconomic status</topic><topic>Socioeconomics</topic><topic>Squatters</topic><topic>The Gambia</topic><topic>underweight</topic><topic>Urine</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Weaning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Panter-Brick, Catherine</creatorcontrib><creatorcontrib>Lunn, Peter G.</creatorcontrib><creatorcontrib>Langford, Rebecca M.</creatorcontrib><creatorcontrib>Maharjan, Makhan</creatorcontrib><creatorcontrib>Manandhar, Dharma S.</creatorcontrib><collection>AGRIS</collection><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Panter-Brick, Catherine</au><au>Lunn, Peter G.</au><au>Langford, Rebecca M.</au><au>Maharjan, Makhan</au><au>Manandhar, Dharma S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal</atitle><jtitle>British journal of nutrition</jtitle><addtitle>Br J Nutr</addtitle><date>2009-02-28</date><risdate>2009</risdate><volume>101</volume><issue>4</issue><spage>558</spage><epage>567</epage><pages>558-567</pages><issn>0007-1145</issn><eissn>1475-2662</eissn><coden>BJNUAV</coden><abstract>Early childhood growth retardation persists in developing countries despite decades of nutritional interventions. Adequate food is necessary, but not sufficient, to ensure normal growth where there is ubiquitous exposure to infection. Pathways associated with infection, small intestinal mucosal damage and chronic immunostimulation remain largely undemonstrated in countries other than The Gambia. We conducted a longitudinal study of one squatter and one middle-class group (n 86, 3–18 month olds) to assess these relationships in Nepal. Growth, mucosal damage index (MDI; urinary lactose:creatinine ratio adjusted for body weight), morbidity reports, and blood concentrations of albumin, α-1-acid glycoprotein, IgG and Hb, were recorded monthly. Growth status worsened dramatically from 6 to 18 months, with squatters more stunted (height-for-age Z-score (HAZ), P < 0·001) and underweight (weight-for-age Z-score (WAZ), P = 0·009) than middle class. IgG increased with age, was elevated in squatter children, and negatively related to WAZ (P = 0·034). MDI showed significant negative associations with growth performance, explaining 9 and 19 % of height and weight deficits (ΔHAZ, P = 0·004; ΔWAZ, P < 0·001). Unexpectedly, these associations were weaker in squatter children, namely in the group which showed poorer growth, elevated morbidity, greater pathogen exposure (IgG) and higher MDI (P < 0·001). In Nepal, as in The Gambia, children exhibit poor growth, mucosal damage and immunostimulation. The relative impact of pathways associated with infection and undernutrition may, however, differ across socio-economic groups: in poorer children, the impact of mucosal damage and immunostimulation could be masked by nutritional constraints. This has important implications for public health interventions.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>18662426</pmid><doi>10.1017/S000711450802744X</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age albumins alpha-1-acid glycoprotein animal injuries Bacterial Infections - immunology Bacterial Infections - physiopathology Biological and medical sciences blood proteins Body Height Body Weight Breast Feeding Case-Control Studies Creatinine Developing Countries Economics Feeding. Feeding behavior Fundamental and applied biological sciences. Psychology glycoproteins Growth Disorders - etiology Growth Disorders - immunology Growth Disorders - physiopathology growth retardation Health promotion height hemoglobin Human and Clinical Nutrition Humans Immune response immunoglobulin G Infant infant development Infant growth infant nutrition Infant Nutritional Physiological Phenomena Infant, Newborn infants intestinal mucosa Intestinal Mucosa - immunology Intestinal Mucosa - microbiology Intestinal Mucosa - pathology Intestinal permeability Intestine, Small Lactose LDCs Longitudinal studies Malnutrition Maternal & child health Middle class Morbidity Nepal Nutritional Status Permeability Poverty Public health Public health policy Small intestine socioeconomic status Socioeconomics Squatters The Gambia underweight Urine Vertebrates: anatomy and physiology, studies on body, several organs or systems Weaning |
| title | Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal |
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