Elevated acute-phase protein in stunted Nepali children reporting low morbidity: different rural and urban profiles

This study examined the associations between severity of stunting, plasma p rotein concentrations and morbidity of 104 Nepali boys, aged 10-14 years, l iving in contrasting environments. Boys from a remote village were compared with three similarly aged urban groups: poor squatters, homeless street ch ildren, and middle-class schoolchildren. All but the middle-class group wer e stunted, particularly village boys whose mean height-for-age z-score (-2. 97, SD 0.82) indicates severe growth retardation. Stunting was significantl y associated with increased plasma levels of the acute-phase protein alpha (1)-antichymotrypsin itself inversely related to plasma levels of albumin. Plasma ACT levels of village children (mean 1.52 g/l, SD 0.43) were three t o four times higher than those of squatters and homeless street children, a nd five times higher than those of middle-class boys. Despite being the mos t severely stunted and having the most abnormal plasma protein values, vill age children reported the lowest burden of disease, a contradiction which m ay reflect exposure to sub-clinical infections or habituation to illness an d low expectation of treatment. This study draws attention to the strikingl y high levels of ACT and of stunting in the rural sample, and cautions on t he use of uncorroborated morbidity reports across different epidemiological and socio-ecological environments. Possible mechanisms to explain the impa ct of illness and inflammation on growth faltering are discussed.