Elevated Fecal Alpha-1-antitrypsin (AAT) Levels in Stunted Children: Study in Agricultural Areas

The prevalence of stunting in agricultural areas is relatively high. Pesticide exposure can cause digestive tract inflammation known as environmental enteric dysfunction (EED), which interferes with nutrient absorption, resulting in impaired growth. Fecal Alpha-1-antitrypsin (AAT) is a parameter to measure the presence of EED. The increase in fecal AAT levels in stunted children in agricultural areas is not yet known. This study aims to prove that the levels of fecal AAT in stunted children are higher than in normal children. This research is an observational study with a cross-sectional approach. The research location was in Dukuhlo Village, Brebes Regency, Indonesia, which is a shallot farming area with high pesticide use intensity, from April to July 2023. The subjects were 70 children aged 8-12 years (32 stunted and 38 normal). Measuring AAT levels in stool preparations was carried out using the Enzyme-Linked Immunosorbent Assay (ELISA) Sandwich method. Data were analyzed using an independent t-test, Mann-Whitney, and chi-square. The stunting and normal groups differed in age (p=0.048), birth weight (p=0.048), and involvement of children in agricultural activities (p=0.041). Fecal AAT levels in stunted children (24.50 ng/ml) were higher than in normal children (13.05 ng/ml) (p=0.045). Children with fecal AAT levels ≥18.05 ng/mL have a 4.2 times higher risk of becoming stunted. There was an increase in fecal AAT levels in stunted children in agricultural areas.