Elevated acute-phase protein in stunted Nepali children reporting low morbidity: different rural and urban profiles

Abstract

This study examined the associations between severity of stunting, plasma protein concentrations and morbidity of 104 Nepali boys, aged 10±14 years, living in contrasting environments. Boys from a remote village were compared with three similarly aged urban groups: poor squatters, homeless street children, and middle-class schoolchildren. All but the middle-class group were stunted, particularly village boys whose mean height-for-age z-score (22´97, SD 0´82) indicates severe growth retardation. Stunting was significantly associated with increased plasma levels of the acute-phase protein a 1 -antichymotrypsin itself inversely related to plasma levels of albumin. Plasma ACT levels of village children (mean 1´52 g/l, SD 0´43) were three to four times higher than those of squatters and homeless street children, and five times higher than those of middle-class boys. Despite being the most severely stunted and having the most abnormal plasma protein values, village children reported the lowest burden of disease, a contradiction which may reflect exposure to sub-clinical infections or habituation to illness and low expectation of treatment. This study draws attention to the strikingly high levels of ACT and of stunting in the rural sample, and cautions on the use of uncorroborated morbidity reports across different epidemiological and socio-ecological environments. Possible mechanisms to explain the impact of illness and inflammation on growth faltering are discussed.

Micronutrients in childhood and the influence of subclinical inflammation

“…Fever and persistent diarrhoeas are common early symptoms in HIV-infected children (Dobosz & Marczynska, 2004), and Filteau et al (1995) have also found diarrhoea in the previous week to be associated with several elevated acute-phase proteins in preschool Ghanaian children. Panter-Brick et al (2001) have reported that stunting is associated with high plasma ACT concentrations in Nepali village children even though morbidity appears to be low. Northrop-Clewes et al (1994) have also reported that mean plasma ACT concentrations are elevated in >50 % of apparently-healthy Gambian infants every month over 1 year.…”

Life history theory and the immune system: Steps toward a human ecological immunology

“…As such, they can be measured as a nonspecific indicator of the degree of investment in antipathogen defenses. Panter-Brick et al (2000) reported a negative association between ACT concentration and height-for-age z-scores (HAZ) in Nepali children.…”

Homeless street children in Nepal: Use of allostatic load to assess the burden of childhood adversity

“…To date we have reported marked group differences in the physical markers of well-being indicating that the homeless street boys did not have the worst outcomes in terms of growth status and pathogen load, and documenting a marked contrast between urban and rural conditions. Height status was worst in villagers and acute-phase protein indices of pathogen load were greatest even though villagers reported the least morbidity (Panter-Brick, Lunn, Baker, & Todd, 2001;Panter-Brick, Todd, Baker, & Worthman, 1996). Indeed, the observed discordance between self-reported symptoms and infection status raised our interest in biomarkers to assess health status.…”

“…Assay detection limit is 0.02 g/l; within-and between-assay CVs for low and high controls (0.24 and 0.59 g/l) run 3 and 4%, and 5 and 8%, respectively. Procedure, performance, and quality control for the results reported here are detailed elsewhere (Adelekan et al, 2003;Panter-Brick et al, 2001). ACT rises rapidly and remains elevated in response to pathogen exposure, and thus acts as an indicator of pathogen challenge in subclinical and chronic infection (Adelekan et al, 2003;Thompson, Milford-Ward, & Whicher, 1992).…”