ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2018) 15 13.23 | DOI: 10.1530/ey.15.13.23

Department of Anthropology, Hunter College, City University of New York, New York, NY, USA


To read the full abstract: Proc Natl Acad Sci USA 2018; 115(17) E3914-E3921

Pediatric endocrinologists have long known that chronic disease, such as severe asthma or inflammatory bowel disease, leads to slower growth and short stature. But it is not always clear whether this is due to the disease (decreased oxygen to the tissues, decreased absorption of calories, infections), to the treatment (corticosteroid exposure) or to a combination of the two. Pediatric endocrinologists also know that optimization of caloric intake and weight is associated with a better prognosis in children with chronic inflammatory diseases.

The provocative hypothesis tested by Urlacher et al. is that low level inflammation, which does not have severe, visible consequences on the child (such as anorexia or decreased physical activity), contributes to stunting. Their study was performed in a population of children living with chronic parasitic infection in a very low resource setting. In this cross-sectional and longitudinal study, they investigated the relationship between levels of C-reactive protein (CRP, a measure of acute immune activity indicating mild, but costly, systemic inflammation over a period of days), IgG (an intermediate-duration measure of adaptive humoral immune function against viruses and bacteria over a period of months) and IgE (a measure of chronic, relatively low-cost, anti-parasitic adaptive immune function over a period of several years), on short-term (1 week) and long-term (20 months) growth. They observed that increased inflammation was associated with slower growth. They also introduced the concept of “trade-off”, meaning that the calories used to develop and maintain the inflammatory response can’t be used for growth. Finally, they observe that this mechanism is mostly relevant to children with insufficient fat reserves, suggesting that better nutrition could alleviate the detrimental effects of chronic inflammation.

The effect of such a mechanism on growth in resource-limited settings is unknown, but chronic, low grade inflammatory response could represent an additional mechanism contributing to stunting and, therefore, to the development of non-communicable diseases (such as Type 2 diabetes). Whether chronic low-grade inflammation in the pregnant mother would also affect fetal growth and contribute to intra uterine growth retardation is another intriguing question.

Article tools

My recent searches

No recent searches.