Identification of etiology-specific diarrhea associated with linear growth faltering in Bangladeshi infants

Identification of etiology-specific diarrhea associated with linear growth faltering in... Abstract Childhood diarrhea in low-resource settings has been variably linked to linear growth shortfalls. However, the association between etiology-specific diarrhea and growth has not been comprehensively evaluated. We tested diarrheal stools collected from the Performance of Rotavirus and Oral Polio Vaccines in Developing Countries study from 2011-2013 in Dhaka, Bangladesh by quantitative polymerase chain reaction for a broad range of enteropathogens to characterize diarrhea etiology and examine the association between etiology-specific diarrhea and linear growth and systemic inflammation. Pathogen-specific burdens of diarrhea were determined using attributable fractions. Linear regression was used to examine associations of pathogen-specific diarrhea with length-for-age z-scores (LAZ) and serum C-reactive protein. There was no relationship between all-cause diarrhea and length at 12 months (-0.01 change in 12-month LAZ per episode; 95% confidence interval: -0.06, 0.03). However, Cryptosporidium (-0.23 change in 12-month LAZ per attributable episode; 95% CI: -0.50, 0.03), Campylobacter jejuni/coli (-0.16; 95% CI: -0.32, -0.01) and Shigella/enteroinvasive E. coli diarrhea (-0.12; 95% CI: -0.26, 0.03) were associated with linear growth deficits. C. jejuni/coli and Shigella/enteroinvasive E. coli attributable diarrhea were associated with elevated C-reactive protein. The association between diarrhea and linear growth appears to be pathogen specific, reinforcing the need for pathogen-specific interventions. diarrhea, children, qPCR, growth, stunting © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Epidemiology Oxford University Press

Identification of etiology-specific diarrhea associated with linear growth faltering in Bangladeshi infants

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Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
ISSN
0002-9262
eISSN
1476-6256
D.O.I.
10.1093/aje/kwy106
Publisher site
See Article on Publisher Site

Abstract

Abstract Childhood diarrhea in low-resource settings has been variably linked to linear growth shortfalls. However, the association between etiology-specific diarrhea and growth has not been comprehensively evaluated. We tested diarrheal stools collected from the Performance of Rotavirus and Oral Polio Vaccines in Developing Countries study from 2011-2013 in Dhaka, Bangladesh by quantitative polymerase chain reaction for a broad range of enteropathogens to characterize diarrhea etiology and examine the association between etiology-specific diarrhea and linear growth and systemic inflammation. Pathogen-specific burdens of diarrhea were determined using attributable fractions. Linear regression was used to examine associations of pathogen-specific diarrhea with length-for-age z-scores (LAZ) and serum C-reactive protein. There was no relationship between all-cause diarrhea and length at 12 months (-0.01 change in 12-month LAZ per episode; 95% confidence interval: -0.06, 0.03). However, Cryptosporidium (-0.23 change in 12-month LAZ per attributable episode; 95% CI: -0.50, 0.03), Campylobacter jejuni/coli (-0.16; 95% CI: -0.32, -0.01) and Shigella/enteroinvasive E. coli diarrhea (-0.12; 95% CI: -0.26, 0.03) were associated with linear growth deficits. C. jejuni/coli and Shigella/enteroinvasive E. coli attributable diarrhea were associated with elevated C-reactive protein. The association between diarrhea and linear growth appears to be pathogen specific, reinforcing the need for pathogen-specific interventions. diarrhea, children, qPCR, growth, stunting © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Journal

American Journal of EpidemiologyOxford University Press

Published: May 15, 2018

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