Objectives
To examine associations between stunting and acute phase proteins (APPs) on biomarkers of inflammation in children under 5y from 16 cross-sectional national nutrition surveys
Methods
Height-for-age z-score (HAZ) and inflammation data of 48,150 children from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) collaboration database were analyzed. Quasi-poisson bivariate models were used to estimate stunting (HAZ <-2SD based on WHO standards) prevalence ratios (PR, 95%CI) with biomarkers of inflammation (alpha-1 acid glycoprotein (AGP) > 1 g/L and C-reactive protein (CRP) > 5 mg/L) as predictors. Taylor series variance estimation based on pooled, and country-specific complex survey design effects was used
Results
Overall stunting prevalence was 23.5% and ranged from 3.0% (USA) to 51.0% (Laos). Pooled elevated CRP prevalence was 15.4%, ranging from 6.2% (USA) to 40.1% (Cote D’ivoire) and pooled elevated AGP prevalence 37.5% (21.0% in Philippines to 64.7% in Cote D’ivoire). Absolute differences of population prevalence ranged 6-8 %( pooled) among non-stunted/non-inflamed compared to stunted and inflamed and marginal concentrations of AGP and CRP were significantly lower in non-stunted compared to stunted children (geometric mean AGP=0.90(95% CI: 0.89-0.91) vs 0.96(0.94-0.97)g/L; CRP=0.66(0.65-0.67) vs 1.04(0.98-1.10)mg/L, each p<.0001). These acute phase proteins were associated with increased stunting (AGP>1 PR=1.43(1.25, 1.63); CRP > 5 PR=1.20(1.12, 1.29)
Conclusions
Childhood stunting is associated with inflammation and the magnitude of association varies across countries and by inflammation biomarker. The relationship between stunting and inflammation requires attention to better understand the role of inflammation in nutritional assessment
