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Salivary cortisol and heart rate in stunted and nonstunted Nepalese school children

European Journal of Clinical Nutrition volume 57, pages 1458–1465 (2003)Cite this article

Abstract

Objective: To test the hypothesis that stunted Nepalese children have an altered stress response system when compared with matched nonstunted children in response to a battery of psychological tests.

Design: Case–control study.

Setting: Poor urban areas of Kathmandu, Nepal.

Subjects: A total of 64 stunted (less than –2 s.d. height-for-age) children compared with 64 nonstunted (> −1s.d. height-for-age) schoolchildren between 8 and 10 y old matched for school and sex.

Methods: A psychological test session was administered, which included mental arithmetic and two tests of working memory. Salivary cortisol samples were obtained at five points during testing, and heart rate was measured during testing and also at baseline. Salivary cortisol samples were also obtained once early in the morning. Hemoglobin was assessed at the testing session, and extensive data were obtained on the social background of the children's families.

Results: Stunted Nepalese children showed a blunted physiologic response (salivary cortisol and heart rate) to psychological stressors (P<0.05) when compared with nonstunted children, but were not different from the nonstunted children in baseline measures, when controlling for social background. The two groups were not different in terms of social background.

Conclusions: These findings suggest that childhood growth retardation may be associated with changes in physiological arousal, and that stunting could be associated with hyporesponsivity in response to psychological stress.

Sponsorship: DFID (The Department for International Development, UK).

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Acknowledgements

We are grateful to Purna Shrestha and Bimala Manadhar at the Mother Infant Research Activities in Kathmandu, Nepal, for their support and assistance, as well as Kamala Manadhar, Ganga Ranjitkar, Sharmila Karki and Sheela Sainju who tested all of the children. Thanks are also due to David Osrin, Wendy Morris, Suzanne Filteau, Andrew Tomkins and Juana Willumsen, in addition to the anonymous reviewers of this journal, and to all of the children and families for their participation in this research. The work was undertaken by the Institute of Child Health and Great Ormond Street Hospital for Sick Children NHS Trust, who receive a proportion of their funding from the NHS Executive.

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Author notes

  1. L C Fernald: Guarantor: LC Fernald.

  2. L C Fernald, S M Grantham-McGregor, D S Manandhar and A Costello: Contributors: LCF was responsible for the study design, data collection, sample analysis, data analysis and manuscript preparation. SMG-M oversaw all aspects of the study including logistics, data collection and analysis, and substantially contributed to manuscript preparation. DSM oversaw many aspects of the field work in Nepal and reviewed the manuscript. AC was lead author for the grant to fund the study, is the primary collaborator with the Nepalese research group and contributed to the preparation of the manuscript.

Authors and Affiliations

  1. Institute for Business and Economic Research, University of California, Berkeley, CA, USA

    L C Fernald

  2. National Institute of Public Health, Cuernavaca, Mexico

    L C Fernald

  3. Centre for International Child Health, Institute of Child Health, University College, London, London, UK

    S M Grantham-McGregor & A Costello

  4. Mother Infant Research Activities (MIRA), Kathmandu, Nepal

    D S Manandhar

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  1. L C Fernald
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  3. D S Manandhar
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  4. A Costello
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Correspondence to L C Fernald.

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Fernald, L., Grantham-McGregor, S., Manandhar, D. et al. Salivary cortisol and heart rate in stunted and nonstunted Nepalese school children. Eur J Clin Nutr 57, 1458–1465 (2003). https://doi.org/10.1038/sj.ejcn.1601710

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