Fecal markers of intestinal inflammation and permeability associated with the subsequent acquisition of linear growth deficits in infants

Abstract

Enteric infections are associated with linear growth failure in children. To quantify the association between intestinal inflammation and linear growth failure three commercially available enzyme-linked immunosorbent assays (neopterin [NEO], alpha-anti-trypsin [AAT], and myeloperoxidase [MPO]) were performed in a structured sampling of asymptomatic stool from children under longitudinal surveillance for diarrheal illness in eight countries. Samples from 537 children contributed 1,169 AAT, 916 MPO, and 954 NEO test results that were significantly associated with linear growth. When combined to form a disease activity score, children with the highest score grew 1.08 cm less than children with the lowest score over the 6-month period following the tests after controlling for the incidence of diarrheal disease. This set of affordable non-invasive tests delineates those at risk of linear growth failure and may be used for the improved assessments of interventions to optimize growth during a critical period of early childhood.

Figure 1.

One thousand three hundred and twenty-one samples from 611 children from eight countries were evaluated for fecal levels of neopterin (NEO), myeloperoxidase (MPO), and alpha-anti-trypsin (AAT). Samples used in the growth analysis were restricted to stools from children with no history of diarrhea in the last 7 days or history of lactulose administration on the day of or before stool collection and for which complete anthropometric data were available.