Association between stunting and fecal calprotectin levels in breastfed infants living in a rural area of the Democratic Republic of the Congo: a cross sectional study

Background: Stunting is a major public health problem in low- and middle-income countries as in Democratic Republic of the Congo (DRC). Many factors, such as environmental enteric dysfunction (EED), are incriminated in the pathogenesis of stunting. EED, characterized by intestinal inflammation, can be evaluated by a non-invasive marker, the fecal calprotectin (FC). The aim of this study was to determine the concentration of FC, to compare the FC of exclusively breastfed infants with that of mixed-fed infants, and to assess the association between the stunting and the FC in infants aged 4 to 7 months. Methods: Socio-demographic, nutritional, and clinical data were collected in infants aged 4 to 7 months attending child welfare clinic activities from eight targeted rural health areas of South-Kivu province, eastern DRC. A single assay of calprotectin was performed in stool samples by Bühlmann Quantum Blue® Calprotectin Extended device. Results: A total of 240 infants (median age: 6 months, interquartile range: 5-6 months) were enrolled in this study. Among them, 41 (17.1%) were stunted. The median FC was 87 µg/g of stool. Exclusive breastfed infants had significantly higher FC compared to mixed-fed infants (median FC: 108 µg/g versus 79 µg/g, p=0.031). In addition, stunted infants had higher FC levels (107 µg/g) compared to infants with normal length for age (82 µg/g) but without reaching the statistical significance level (p= 0.41). Conclusion: This study shows higher FC levels in exclusively breastfed and in stunted infants living in rural areas of South Kivu. Further studies are needed to assess the prevalence of EED and its association with stunting in the DRC. Keywords: Stunting; fecal calprotectin; infants; breastfeeding.