Catherine Panter?Brick|P. G. Lunn|Rebecca Langford|Makhan Maharjan|Dharma Manandhar
Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal
Durham University|University of Cambridge|Durham University|Environment and Public Health Organisation|Mother and Infant Research Activities
early childhood growth retardation persists developing countries despite decades nutritional interventions adequate food necessary sufficient ensure normal growth ubiquitous exposure infection pathways associated infection small intestinal mucosal damage chronic immunostimulation remain largely undemonstrated countries gambia conducted longitudinal study one squatter one middleclass group n 86 318 month olds assess relationships nepal growth mucosal damage index mdi urinary lactosecreatinine ratio adjusted body weight morbidity reports blood concentrations albumin 1acid glycoprotein igg hb recorded monthly growth status worsened dramatically 6 18 months squatters stunted heightforage z score haz p lt 0001 underweight weightforage z score waz p 0009 middle class igg increased age elevated squatter children negatively related waz p 0034 mdi showed significant negative associations growth performance explaining 9 19 height weight deficits haz p 0004 waz p lt 0001 unexpectedly associations weaker squatter children namely group showed poorer growth elevated morbidity greater pathogen exposure igg higher mdi p lt 0001 nepal gambia children exhibit poor growth mucosal damage immunostimulation relative impact pathways associated infection undernutrition may however differ across socioeconomic groups poorer children impact mucosal damage immunostimulation could masked nutritional constraints important implications public health interventions