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Stunting is characterized by chronic inflammation in Zimbabwean infants (620.4)
Author(s) -
Prendergast Andrew,
Rukobo Sandro,
Chasekwa Bernard,
Mutasa Kuda,
Ntozini Robert,
Mbuya Mduduzi,
Jones Andrew,
Moulton Lawrence,
Stoltzfus Rebecca,
Humphrey Jean
Publication year - 2014
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.28.1_supplement.620.4
Subject(s) - medicine , igfbp3 , odds ratio , inflammation , logistic regression , in utero , multivariate analysis , gastroenterology , physiology , pregnancy , growth factor , biology , fetus , receptor , genetics
Background Stunting affects one‐third of children in developing countries, but the causes remain unclear. The objective of this study was to investigate whether low‐grade inflammation suppresses the growth hormone‐IGF axis and mediates stunting. Methods We conducted a case‐control study of 202 HIV‐unexposed Zimbabwean infants who were stunted (height‐for‐age Z‐score (HAZ)<‐2; cases) or non‐stunted (HAZ>‐0.5; controls) at 18mo. We measured biomarkers of intestinal damage (I‐FABP), inflammation (CRP, AGP, IL‐6) and growth hormone‐IGF axis (IGF‐1, IGFBP3) in infant plasma at 6w and 3, 6, 12 and 18mo, and in paired maternal‐infant plasma at birth. Adjusted mean differences between biomarkers were estimated using regression models. Multivariate odds ratios of stunting were estimated by logistic regression. Results At birth, cases were shorter than controls and their mothers had lower levels of IGF‐1 (adjusted mean difference(95%CI) ‐21.4(‐39.8, ‐3.1) ng/mL). From 6w‐12mo of age, levels of CRP and AGP were consistently higher and IGF‐1 and IGFBP3 lower in cases versus controls; IGF‐1 correlated inversely with inflammatory markers at all time‐points. I‐FABP increased between 3‐12mo, indicating extensive intestinal damage, which was similar in cases and controls. In multivariate analysis, higher levels of CRP (aOR 3.06 (95%CI 1.34, 6.99); P=0.008) and AGP (aOR 7.87 (95%CI 0.74, 83.74); P=0.087) during infancy were associated with stunting. Conclusions Stunting began in utero and was associated with low maternal IGF‐1 at birth. Inflammatory markers were higher in cases than controls from 6w of age and were associated with lower levels of IGF‐1 throughout infancy. Higher levels of CRP and AGP during infancy were associated with stunting. These findings suggest that an extensive enteropathy occurs during infancy and that low‐grade chronic inflammation may impair infant growth. Grant Funding Source : Supported by Wellcome Trust (UK)