Skip to main content
×
Home
    • Aa
    • Aa

Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal

  • Catherine Panter-Brick (a1), Peter G. Lunn (a2), Rebecca M. Langford (a1), Makhan Maharjan (a3) and Dharma S. Manandhar (a4)...
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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal
      Available formats
      ×
Copyright
Corresponding author
*Corresponding author: Professor C. Panter-Brick, fax +44 (0)191 3346101, email catherine.panter-brick@durham.ac.uk
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1R Shrimpton , CG Victora , M de Onis , RC Lima , M Blössner & G Clugston (2001) Worldwide timing of growth faltering: implications for nutritional interventions. Pediatrics 107, e75.

5ZA Bhutta , T Ahmed , RE Black , (2008) What works? Interventions for maternal and child undernutrition and survival. Lancet 371, 417440.

7NW Solomons , M Mazariegos , KH Brown & K Klasing (1993) The underprivileged, developing country child: environmental contamination and growth failure revisited. Nutr Rev 51, 327332.

12T Moffat (2003) Diarrhea, respiratory infections, protozoan gastrointestinal parasites, and child growth in Kathmandu, Nepal. Am J Phys Anthropol 122, 8587.

15A Costello (1989) Growth velocity and stunting in rural Nepal. Arch Dis Child 64, 14781482.

21CA Northrop-Clewes , PG Lunn & RM Downes (1997) Lactose maldigestion in breast-feeding Gambian infants. J Pediatr Gastroenterol Nutr 24, 257263.

22V Matos , G van Melle , O Boulat , M Markert , C Bachmann & JP Guignard (1997) Urinary phosphate/creatinine, calcium/creatinine and magnesium/creatinine ratios in a healthy pediatric population. J Pediatr 131, 252257.

24CA Northrop , PG Lunn & RH Behrens (1990) Automated enzymatic assays for the determination of intestinal permeability probes in urine. 1. Lactulose and lactose. Clin Chim Acta 187, 7988.

27S Travis & I Menzies (1992) Intestinal permeability: functional assessment and significance. Clin Sci 82, 471488.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: