Systemic inflammation, growth factors, and linear growth in the setting of infection and malnutrition

Abstract

ObjectivesDeficits in weight gain and linear growth are seen frequently among children in areas where malnutrition and recurrent infections are common. Although both inflammation and malnutrition can result in growth hormone (GH) resistance, the interrelationships of infection, inflammation, and growth deficits in developing areas remain unclear. The aim of this study was to evaluate relationships between low levels of systemic inflammation, growth factors, and anthropometry in a case–control cohort of underweight and normal weight children in northern Brazil.MethodsWe evaluated data from 147 children ages 6 to 24 mo evaluated in the MAL-ED (Interactions of Malnutrition and Enteric Disease) case–control study following recruitment from a nutrition clinic for impoverished families in Fortaleza, Brazil. We used nonparametric tests and linear regression to evaluate relationships between current symptoms of infections (assessed by questionnaire), systemic inflammation (assessed by high-sensitivity C-reactive protein [hsCRP]), the GH insulin-like growth factor-1 (IGF-1) axis, and measures of anthropometry. All models were adjusted for age and sex.ResultsChildren with recent symptoms of diarrhea, cough, and fever (compared with those without symptoms) had higher hsCRP levels; those with recent diarrhea and fever also had lower IGF-1 and higher GH levels. Stool myeloperoxidase was positively associated with serum hsCRP. hsCRP was in turn positively associated with GH and negatively associated with IGF-1 and IGF-binding protein-3 (IGFBP-3), suggesting a state of GH resistance. After adjustment for hsCRP, IGF-1 and IGFBP-3 were positively and GH was negatively associated with Z scores for height and weight.ConclusionsInfection and inflammation were linked to evidence of GH resistance, whereas levels of GH, IGF-1, and IGFBP-3 were associated with growth indices independent of hsCRP. These data implicate complex interrelationships between infection, nutritional status, GH axis, and linear growth in children from a developing area.

Early Enteral Nutrition Adequacy Mitigates the Neutrophil–Lymphocyte Ratio Improving Clinical Outcomes in Critically Ill Surgical Patients

“…Several studies have explored the triad of disease/injury, systemic inflammation, and malnourishment. The stress released by disease/injury and metabolism and comorbidities altered by the inflammatory response and malnourishment make the triad highly associated with risk of mortality . One plausible mechanism through which EN may mitigate inflammation is via interactions with the gut‐associated lymphoid tissue (GALT).…”

“…A total of 161 patients with available F-NLR was included in the analysis; 68% were male, with a median age of 62 (range, 52-72) years and a median BMI of 27 (range, [23][24][25][26][27][28][29][30]. Details are listed in Table 1.…”

“…The stress released by disease/injury and metabolism and comorbidities altered by the inflammatory response and malnourishment make the triad highly associated with risk of mortality. 8,21,[27][28][29] One plausible mechanism through which EN may mitigate inflammation is via interactions with the gut-associated lymphoid tissue (GALT). Xi et al demonstrated that prolonged fasting and delayed EN initiation in critically ill patients increases the inflammatory response.…”

Inflammatory biomarkers in infective endocarditis: machine learning to predict mortality

“…Growth factors are biologically active cytokines or proteins that can promote or inhibit cellular growth [19]. Lower levels of growth factors are often seen during systemic inflammation, which may affect the healing process [20].…”

Mice with infectious colitis exhibit linear growth failure and subsequent catch-up growth related to systemic inflammation and IGF-1

“…The underlying mechanisms of poor linear growth in these settings remain unclear including whether the weight and height deficits are related to decreased food intake, systemic inflammation, poor absorption of nutrients, and dysregulation of systemic growth factors such as insulin-like growth factor (IGF)-1 [3, 4]. Persistent length/height measurement of more than two standard deviations below the mean (i.e., stunting) affects many of these children, even after resolution of the intestinal infections [5, 6]. Other children exhibit compensatory catch-up growth, an accelerated growth velocity that partially or completely normalizes their height [7, 8].…”