Biochemical markers of health for children with poor anthropometric status in urban Nepal

Abstract

This study examines the relationship between poor anthropometric status and biochemical markers in children in urban poor Nepal. To date, no study has examined poor nutritional status in the urban poor children in relation to biochemical markers to explain the conditions of children's health in polluted squatter environments, nor considered possible associations with weaning practices. In a cross-sectional study, 0-60 month old squatter children were examined antliropometric status, intestinal mucosal function (intestinal permeability), clinical/sub-clinical inflammation status (acute-phase protein) and parasitic infection. 210 children were measured for height (or length) and weight, 167 for intestinal pemeability (lactulose/mannitol ratio: L/M ratio) and 173 for acute- phase protein (C-reactive protein: CRP) and parasitic infection. Data on weaning practices and morbidity were collected from 172 motliers/guardians. No significant relationships were found between antliropometric status per se and the levels of L/M ratio or CRP. The L/M ratio (0.26) was poorer than that of UK children (0.12) but similar to that found in studies of children in Bangladesh (0.24). Giardia cases (N=8) had worse L/M ratios than those non-infected (0.43 versus 0.25 respectively, p=0.014). A measure of weanmg practices, a longer period of lactation, was associated with poorer intestinal permeability (p=0.03l), as well as with poorer height-for-age (p=0.024) in children who had ceased breastfeeding. Also, the maternal morbidity reports reflected the current health status of children: high CRP values, reflecting acute-inflammation status, were associated with reported illness on the day of interview (p=0.004) but not with the preceding 7 days' reports. This study showed the importance of weaning practices as a two-stage process - the onset of supplementation and the cessation of breastfeeding. These two stages may have a differential impact on children's health in early life stage and poor nutritional status. Maternal report was useful as a proxy for child morbidity, sensitively reflecting children's acute illness in urban Nepal.