The relationship between malnutrition and TH2 immune markers: a study in school-aged children of different socio-economic backgrounds in Makassar, Indonesia

objective The burden of underweight remains a major problem in Indonesia, and at the same time, the prevalence of overweight is increasing. Malnutrition is a major determinant of health and has been linked to allergic disorders in children. We examined the relationship between malnutrition and TH2 immune markers in school-aged children in Makassar, Indonesia. methods A cross-sectional study was performed in five schools where socio-demographic characteristics were recorded. Children’s standardised z-scores of body mass index (z-BMI) and age- standardised z-scores of height (z-HA) were assessed using WHO child growth standards. Skin prick test (SPT) reactivity was determined to house dust mite allergens. Helminth infection status, (growth) hormones including insulin-like growth factor (IGF-1) and TH2 immune markers were measured. results In total, 954 children were included of whom 21.6% were underweight and 14.8% overweight. After controlling for confounders, overweight was positively associated with leptin (GMR 3.55, 95% CI: 2.99–4.23) and IGF-1 (GMR 1.45, 95% CI: 1.15–1.82), whereas underweight was negatively associated (respectively GMR 0.57, 95% CI: 0.49–0.66 and GMR 0.78, 95% CI: 0.63–0.97). Underweight was associated with a lower eosinophil count (GMR 0.79, 95% CI: 0.64– 0.97) but not with total IgE levels or SPT reactivity. Overweight was positively associated with SPT reactivity (adjusted OR 2.68, 95% CI: 1.50–4.78) but no relationship was found with the other TH2 immune markers. conclusion Malnutrition is prominent in school-aged children in Makassar, with overweight associated with increased SPT reactivity. Therefore, interventions should focus on undernutrition, but also on overweight to prevent the increase of allergic disorders in Indonesia.