University of Oulu

Kenneth Maleta, Yue-Mei Fan, Juho Luoma, Ulla Ashorn, Jaden Bendabenda, Kathryn G Dewey, Heikki Hyöty, Mikael Knip, Emma Kortekangas, Kirsi-Maarit Lehto, Andrew Matchado, Minyanga Nkhoma, Noora Nurminen, Seppo Parkkila, Sami Purmonen, Riitta Veijola, Sami Oikarinen, Per Ashorn, Infections and systemic inflammation are associated with lower plasma concentration of insulin-like growth factor I among Malawian children, The American Journal of Clinical Nutrition, Volume 113, Issue 2, February 2021, Pages 380–390,

Infections and systemic inflammation are associated with lower plasma concentration of insulin-like growth factor I among Malawian children

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Author: Maleta, Kenneth1; Fan, Yue-Mei2; Luoma, Juho2;
Organizations: 1School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
2Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
3Institute for Global Nutrition and Department of Nutrition, University of California, Davis, CA, USA
4Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
5Fimlab Ltd, Tampere University Hospital, Tampere, Finland
6Paediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
7Research Programs for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
8Folkhälsan Research Centre, Helsinki, Finland
9Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
10Department of Paediatrics, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital and University of Oulu, Oulu, Finland
11Department of Paediatrics, Tampere University Hospital, Tampere, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 4.9 MB)
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Language: English
Published: Oxford University Press, 2021
Publish Date: 2021-05-18


Background: Insulin-like growth factor I (IGF-I) is the most important hormonal promoter of linear growth in infants and young children.

Objectives: The objectives of this study were to compare plasma IGF-I concentration in a low- compared with a high-income country and characterize biological pathways leading to reduced IGF-I concentration in children in a low-income setting.

Methods: We analyzed plasma IGF-I concentration from 716 Malawian and 80 Finnish children at 6–36 mo of age. In the Malawian children, we studied the association between IGF-I concentration and their environmental exposures; nutritional status; systemic and intestinal inflammation; malaria parasitemia and viral, bacterial, and parasitic enteric infections; as well as growth at 18 mo of age. We then conducted a pathway analysis to identify direct and indirect associations between these predictors and IGF-I concentration.

Results: The mean IGF-I concentrations were similar in Malawi and Finland among 6-mo-old infants. At age 18 mo, the mean ± SD concentration was almost double among the Finns compared with the Malawians [24.2 ± 11.3 compared with 12.5 ± 7.7 ng/mL, age- and sex-adjusted difference in mean (95% CI): 11.8 (9.9, 13.7) ng/mL; P < 0.01]. Among 18-mo-old Malawians, plasma IGF-I concentration was inversely associated with systemic inflammation, malaria parasitemia, and intestinal Shigella, Campylobacter, and enterovirus infection and positively associated with the children’s weight-for-length z score (WLZ), female sex, maternal height, mother’s education, and dry season. Seasonally, mean plasma IGF-I concentration was highest in June and July and lowest in December and January, coinciding with changes in children’s length gain and preceded by ∼2 mo by the changes in their WLZ.

Conclusions: The mean plasma IGF-I concentrations are similar in Malawi and Finland among 6-mo-old infants. Thereafter, mean concentrations rise markedly in Finland but not in Malawi. Systemic inflammation and clinically nonapparent infections are strongly associated with lower plasma IGF-I concentrations in Malawi through direct and indirect pathways.

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Series: American journal of clinical nutrition
ISSN: 0002-9165
ISSN-E: 1938-3207
ISSN-L: 0002-9165
Volume: 113
Issue: 2
Pages: 380 - 390
DOI: 10.1093/ajcn/nqaa327
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This study was funded by the Finnish Funding Agency for Technology and Innovation; the Bill & Melinda Gates Foundation through the University of California, Davis; the Office of Health, Infectious Diseases, and Nutrition, Bureau for Global Health, US Agency for International Development under terms of Cooperative Agreement AID-OAA-A-12-00005 through the Food and Nutrition Technical Assistance III Project, managed by FHI 3603; the Foundation for Paediatric Research in Finland; and the competitive research funding of the Tampere University Hospital (9AA004). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © The Author(s) 2020. Published by Oxford University Press on behalf of the American Society for Nutrition. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.