Urlacher · Proceedings of the National Academy of Sciences of the United States of America 2018 · prospective mixed-longitudinal cohort study · n=261

Tradeoffs between immune function and childhood growth among Amazonian forager-horticulturalists.

Cited 187 times in the scientific literature.

Level 3 - non-randomized controlled study

Prospective mixed-longitudinal cohort study with repeated measures.

PubMed 29632170 · doi:10.1073/pnas.1717522115 · record verified 2026-08-26

What was done

Researchers conducted a prospective mixed-longitudinal study in 261 Amazonian forager-horticulturalist Shuar children (aged 4–11 years) in a high-pathogen, low-resource environment. They collected baseline anthropometry (stature, subcutaneous body fat) and blood immune biomarkers (humoral and cell-mediated immune activity, acute inflammation). In subsamples, linear growth was assessed longitudinally across three distinct time intervals (1 week, 3 months, and 20 months) alongside measures of acute inflammation, and analyzed using multilevel models.

What was found

Elevated immune function showed consistent negative associations with physical growth. During periods of mildly elevated immune activity, children experienced up to a 49% reduction in linear growth. The growth-inhibiting effects were biomarker-specific over timeframes reflecting active energetic competition and were pronounced during costly acute inflammation. Children with higher baseline levels of subcutaneous body fat completely avoided the growth-inhibiting effects of acute inflammation.

Why it matters

This study provides direct field evidence in human children that immune activation trades off against linear growth under resource-limited conditions, demonstrating that body fat serves as a critical energetic buffer against infection-induced growth faltering.

Limits

The study was conducted exclusively in a single indigenous Amazonian population living in high-pathogen conditions, limiting generalizability to well-nourished, industrialized settings. The abstract does not report sample sizes for the specific longitudinal subsamples, exact biomarker cutoffs, confidence intervals, or specific statistical effect sizes beyond the percentage growth reduction.

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