title: Child Stunting is Associated with Low Circulating Essential Amino Acids.
abstract: BACKGROUND
  Stunting affects about one-quarter of children under five worldwide. The pathogenesis of stunting is poorly understood. Nutritional interventions have had only modest effects in reducing stunting. We hypothesized that insufficiency in essential amino acids may be limiting the linear growth of children.
  
  
  METHODS
  We used a targeted metabolomics approach to measure serum amino acids, glycerophospholipids, sphingolipids, and other metabolites using liquid chromatography-tandem mass spectrometry in 313 children, aged 12-59months, from rural Malawi. Children underwent anthropometry.
  
  
  RESULTS
  Sixty-two percent of the children were stunted. Children with stunting had lower serum concentrations of all nine essential amino acids (tryptophan, isoleucine, leucine, valine, methionine, threonine, histidine, phenylalanine, lysine) compared with nonstunted children (p<0.01). In addition, stunted children had significantly lower serum concentrations of conditionally essential amino acids (arginine, glycine, glutamine), non-essential amino acids (asparagine, glutamate, serine), and six different sphingolipids compared with nonstunted children. Stunting was also associated with alterations in serum glycerophospholipid concentrations.
  
  
  CONCLUSIONS
  Our findings support the idea that children with a high risk of stunting may not be receiving an adequate dietary intake of essential amino acids and choline, an essential nutrient for the synthesis of sphingolipids and glycerophospholipids.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: rdsemba@jhmi.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Semba
authors.affiliation: National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Shardell
authors.affiliation: Department of Nutrition & Food Science, College of Agriculture and Natural Resources, University of Maryland, College Park, MD, USA.
authors.forename: Fayrouz A
authors.initials: FA
authors.lastname: Sakr Ashour
authors.affiliation: National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
authors.forename: Ruin
authors.initials: R
authors.lastname: Moaddel
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA; School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Indi
authors.initials: I
authors.lastname: Trehan
authors.affiliation: School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Maleta
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Ordiz
authors.affiliation: Sight and Life, Basel, Switzerland; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kraemer
authors.affiliation: National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Khadeer
authors.affiliation: National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA; School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D000601:Amino Acids, Essential / Q000097:blood*; D002675:Child, Preschool; D002794:Choline / Q000097:blood; D002853:Chromatography, Liquid; D003430:Cross-Sectional Studies; D005260:Female; D020404:Glycerophospholipids / Q000097:blood; D006130:Growth Disorders / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D055432:Metabolomics / Q000379:methods*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013107:Sphingolipids / Q000097:blood; D053719:Tandem Mass Spectrometry
chemical_list: D000601:Amino Acids, Essential; D020404:Glycerophospholipids; D013107:Sphingolipids; D002794:Choline
keywords: Amino acids; Children; Glycerophospholipids; Malnutrition; Sphingolipids; Stunting