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Normative Fecal Calprotectin Concentrations in Guatemalan Preschoolers Are High Relative to Children Reported
María-José Soto-Méndez1, María-Eugenia Romero-Abal, Klaus Schümann
1*Center for Studies of Sensory Impairment, Aging and Metabolism-CeSSIAM, Guatemala City, Guatemala †Molecular Nutrition Unit, ZIEL, Research Center for Nutrition and Food Science, Technische Universität München, Freising, Germany ‡Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain, CIBEROBN.
Insights
Fecal calprotectin levels were elevated in Guatemalan children, suggesting widespread intestinal inflammation potentially linked to environmental sanitation, not specific infections.
Area of Science:
- Pediatric gastroenterology
- Public health epidemiology
- Microbiology
Background:
- Fecal calprotectin indicates intraintestinal inflammation from neutrophils and macrophages.
- It serves as a clinical marker for inflammatory bowel diseases.
- Calprotectin may also be relevant for public health epidemiology.
Purpose of the Study:
- To determine fecal calprotectin distribution in Guatemalan preschool children on a shared institutional diet.
- To compare these levels with pediatric data from other regions.
- To correlate calprotectin levels with indicators of intestinal infection and child characteristics.
Main Methods:
- Fecal samples were collected from 87 children (ages 2-7) across three daycare centers.
- Microscopy, egg counts, Giardia antigen tests, and ELISA for fecal calprotectin were performed.
- Children shared a common institutional menu but varied ecological settings.
Main Results:
- The median fecal calprotectin was 58 mg/kg (mean 98±136 mg/kg), with 61% above the manufacturer's cut-off.
- Elevated levels (51%) exceeded age-adjusted criteria.
- No associations were found with sex, age, growth, or specific microbiological findings; distribution was right-shifted compared to global data.
Conclusions:
- Right-shifted fecal calprotectin status in this population may indicate general stress from poor environmental sanitation.
- Low-grade intestinal infections did not define calprotectin subgroups.
- Findings suggest broader environmental factors influence fecal calprotectin levels in Guatemalan children.
Background:
Calprotectin is a fecal marker of intraintestinal inflammation derived from activated enteric neutrophils and macrophages. It is useful as a clinical marker in inflammatory bowel diseases; furthermore, it may have a role in public health epidemiology.
Objectives:
The aim of the study was to describe the distribution of fecal calprotectin in Guatemalan preschool children sharing a common institutional diet; to relate it collectively to pediatric distributions in other geographic settings, and individually to concomitant indicators of intestinal infection or colonization and other descriptive features of the child.
Methods:
Fecal samples were collected in 87 subjects, ages 2 to 7 years across 3 daycare centers sharing a common institutional menu, but from different ecological settings. Stools were examined, variously by routine light microscopy, quantitative egg counts, and a Giardia antigen test, for microbiological diagnosis, and an ELISA assay for fecal calprotectin (CalproLab).
Results:
The median fecal calprotectin value was 58 mg/kg, with a mean of 98 ± 136 mg/kg and a range from 10 to 950 mg/kg; 61% of values were above the manufacturer's cut-off for elevated concentration and 51% exceeded an age-adjusted criterion. There were no associations between sex, age, growth indicators, or fecal microbiological findings by microscopy or ELISA assays, alone or in combination. The central tendency (mean or median) and distribution were generally shifted to the right in relation to comparable reports from children across the world literature.
Conclusions:
Although specific, low-grade intestinal infections do not define calprotectin subgroups, right-shifted fecal calprotectin status in this population may reflect a general and diffuse stress of adverse environmental sanitation.
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