Immune response in IGF-1 and growth parameters among infected children

Eva Ardianah; Nur Aisiyah Widjaja; Diah Indriani; Soenarnatalina  Melaniani; Kuntoro; Arief Wibowo; Hari Basuki Notobroto; Windhu Purnomo; Rachmah Indawati; Sigit Ari Saputro; Febrina Mustika Santoso; Ria  Puspitasari; Prisma Andita  Pebriaini; Yasmine Nurfidaus; Roedi Irawan; Boerhan Hidayat; Siti Nurul  Hidayati; Meta Herdiana Hanindita

doi:10.22146/bkm.v41i08.18379

Eva Ardianah Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesi https://orcid.org/0000-0003-3648-2008
Nur Aisiyah Widjaja Child Health Department, Dr. Soetomo General Academic Hospital / Child Health Department, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-4253-8760
Diah Indriani Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-7584-2910
Soenarnatalina Melaniani Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-4449-153X
Kuntoro Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-0166-2394
Arief Wibowo Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia
Hari Basuki Notobroto Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-3905-7413
Windhu Purnomo Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia
Rachmah Indawati Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-1151-714X
Sigit Ari Saputro Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University / Center of Excellence for Patient Safety and Quality, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-8904-5525
Febrina Mustika Santoso Child Health Department, Dr. Soetomo General Academic Hospital / Child Health Department, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0009-0001-9022-3149
Ria Puspitasari Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0009-0009-0084-4717
Prisma Andita Pebriaini Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia
Yasmine Nurfidaus Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia
Roedi Irawan Child Health Department, Dr. Soetomo General Academic Hospital / Child Health Department, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0001-5999-4773
Boerhan Hidayat Child Health Department, Dr. Soetomo General Academic Hospital / Child Health Department, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0003-3649-1924
Siti Nurul Hidayati Child Health Department, Dr. Soetomo General Academic Hospital / Child Health Department, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
Meta Herdiana Hanindita Child Health Department, Dr. Soetomo General Academic Hospital / Child Health Department, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia https://orcid.org/0000-0001-8914-0007

DOI: https://doi.org/10.22146/bkm.v41i08.18379

Keywords: growth failure, HAZ/LAZ, IGF-1, inflammatory response, undernutrition

Abstract

Purpose: Infections in children can affect weight gain and linear growth by influencing metabolism and nutrition. Chronic inflammation results in growth failure mediated by pro-inflammatory cytokines and poor nutritional intake, which affects the GH/IGF-1 axis. This study aimed to investigate the impact of the inflammatory response on children's anthropometry, particularly HAZ, and the role of IGF-1.

Methods: An observational study with a cross-sectional design was conducted from September 2021 to July 2022. The study involved children diagnosed with infections. The subjects had undergone a physical and laboratory investigation, which included a thorax photo, urine culture, Mantoux test, and complete blood test in a hospital setting. A complete medical history was obtained from the pediatrician.

Results: The prevalence of undernutrition was 37.33%; the prevalence of underweight/severely underweight, stunted/severely stunted, and wasted/severely wasted was 25.33%, 30.66%, and 14.67% respectively. Stunted/severely stunted was more prevalent in subjects under 2 years old, compared to subjects more than 2 years old (22/41 vs. 7/34, p=0.014). SEM analysis revealed that the inflammatory response affected IGF-1 levels (r=0.850, p=0.000), while IGF-1 affected body composition (r=0.245, p=0.025), and then affected HAZ (r=1.000, p=0.000). The effect of IGF-1 on HAZ appears to be indirect, acting through body composition. Parental height has a weak, albeit significant, effect on body composition (r=0.101, p=0.025) and HAZ (r=0.192, p=0.040). Univariate analysis revealed strong correlations between IL-6 and IL-10 and IGF-1 (r=0.870, p=0.000 and 0.876, p=0.000, respectively). In contrast, parental height showed a correlation with HAZ/LAZ (r=0.319, p=0.000). Maternal height was correlated positively with WAZ (r=0.320, p=0.044).

Conclusion: The prevalence of stunting among children under two years of age indicates that early childhood constitutes a critical period for intervention in growth and development. Inflammatory response has been demonstrated to influence IGF-1 levels in children. The role of IGF-1 on HAZ was mediated by body composition.

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