Objective:To determine to what extent biochemical markers of the nutritional and in¯ammatory status of young children are related to subsequent growth retardation and morbidity. Design: Population-based follow-up study of a cohort of children from admission to ®nal survey round six months later. Setting: Health area in Northern Kivu, Zaire. Subjects: 842 children under two years of age of whom about one-third gave informed consent to capillary blood collection. Main outcome measures: Concentration of albumin, transferrin, transthyretin, a 1 -acid glycoprotein, C-reactive protein, and complement component C3 at baseline, and three and six months later. Incremental growth per 1 month, 3 months and 6 months of follow-up. Cumulative incidence of disease per 1 month and 3 months interval. Results: A high proportion of children was with low concentrations of transport proteins and high concentrations of acute-phase reactants. Weight growth and arm circumference growth did not vary signi®cantly with respect to initial concentrations of biomarkers, but subsequent height growth was lower in children with high values of transferrin, a 1 -acid glycoprotein, and complement component C3 at baseline. Cumulative incidence of malaria, respiratory illness, and diarrhoea was not signi®cantly affected by the concentration of the biomarkers at baseline. Conclusions: In this part of central Africa performing biochemical measurements should not be encouraged as a means for risk scoring in non-hospitalized children. Sponsorship: This research has been carried out on behalf of the Centre Scienti®que et Me Âdical de l'Universite  Libre de Bruxelles pour ses Activite Âs de Coope Âration, which is a non-pro®t organization supported by the Belgian Agency for International Development, and by the European Commission. This work was supported in part by grants from the Fondation Universitaire David et Alice Van Buuren, the Fonds National de la Recherche Scienti®que et Me Âdicale (Contract 3.4526.90.F), the UNICEF representative in Zaire, and the SANRU Basic Rural Health Project (Project 660-0107 USAID, DSP, ECZ). Descriptors: biochemical markers; growth; morbidity; child; Africa; Zaire
IntroductionIn developing countries, many attempts have been made over the last three decades to ®nd early and sensitive indicators of severity and prognosis of protein-energy malnutrition. For that purpose, several clinical, anthropometric, and biochemical measurements have been proposed, re¯ecting alterations related to either malnutrition or infection, as well as their outcomes (Waterlow, 1992). Studies by McLaren, Pellett and Read (1967) in Jordan, and Whitehead, Frood and Poskitt (1971) in Uganda, played a seminal part in stimulating interest in the identi®cation of biochemical markers as means for risk scoring in the ®eld. Since then, a large body of literature has documented the clinical signi®cance and the complex relationships of a number of readily available blood markers of the nutritional status and the phlogistic reaction. These included transpo...