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Association between enteropathogens and malnutrition in children aged 6-23 mo in Bangladesh: a case-control study
James A Platts-Mills1, Mami Taniuchi2, Md Jashim Uddin3
1Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA; and jp5t@virginia.edu.
Insights
A study in Bangladesh identified specific enteropathogens, including E. coli and Giardia, linked to childhood malnutrition. Reducing infection burden is crucial for improving child health and nutritional status in resource-limited settings.
Area of Science:
- Pediatric Nutrition
- Infectious Diseases
- Molecular Diagnostics
Background:
- Early enteropathogen exposure is linked to childhood malnutrition in low-resource settings.
- The specific contribution of individual enteropathogens to malnutrition is not well understood.
- Molecular diagnostics offer enhanced sensitivity for pathogen detection in malnutrition studies.
Purpose of the Study:
- To identify enteropathogens associated with malnutrition in children in Bangladesh.
- To investigate the relationship between specific pathogens and malnutrition using molecular methods.
Main Methods:
- A case-control study enrolled malnourished children (weight-for-age z score [WAZ] <-2) and normal-weight controls (WAZ >-1) aged 6-23 months in Dhaka, Bangladesh.
- Stool samples were collected at enrollment and after a 5-month nutritional intervention for cases.
- Quantitative polymerase chain reaction (qPCR) was used to test for 32 enteropathogens using a custom TaqMan Array Card.
Main Results:
- At enrollment, enteroaggregative Escherichia coli, Campylobacter spp., heat-labile enterotoxin-producing E. coli, Shigella/enteroinvasive E. coli, norovirus genogroup I, and Giardia were significantly associated with malnourished cases.
- The burden of these pathogens remained associated with malnutrition after adjusting for sociodemographic factors.
- The number of pathogens detected at follow-up was negatively associated with WAZ change during intervention, while enrollment pathogen count was positively associated with WAZ change.
Conclusions:
- A specific subset of enteropathogens is demonstrably associated with childhood malnutrition in this Bangladeshi setting.
- Broad public health interventions targeting the reduction of infection burden from these identified pathogens are recommended.
- Further research and integrated strategies are needed to combat malnutrition linked to enteropathogen exposure.
Abstract:
Background: Early exposure to enteropathogens has been associated with malnutrition in children in low-resource settings. However, the contribution of individual enteropathogens remains poorly defined. Molecular diagnostics offer an increase in sensitivity for detecting enteropathogens but have not been comprehensively applied to studies of malnutrition.Objective: We sought to identify enteropathogens associated with malnutrition in Bangladesh.Design: Malnourished children [weight-for-age z score (WAZ) <-2] aged 6-23 mo in Dhaka, Bangladesh, and identified by active community surveillance were enrolled as cases, and normal-weight children (WAZ >-1) of the same age and from the same community were enrolled as controls. Stools were collected at enrollment and, for cases, after a 5-mo nutritional intervention. Enrollment and follow-up stools were tested by quantitative polymerase chain reaction for 32 enteropathogens with the use of a custom-developed TaqMan Array Card.Results: Enteropathogen testing was performed on 486 cases and 442 controls upon enrollment and 365 cases at follow-up. At enrollment, the detection of enteroaggregative Escherichia coli (OR: 1.39; 95% CI: 1.05, 1.83), Campylobacter spp. (OR: 1.46; 95% CI: 1.11, 1.91), heat-labile enterotoxin-producing E. coli (OR: 1.55; 95% CI: 1.04, 2.33), Shigella/enteroinvasive E. coli (OR: 1.65; 95% CI: 1.10, 2.46), norovirus genogroup I (OR: 1.66; 95% CI: 1.23, 2.25), and Giardia (OR: 1.73; 95% CI: 1.20, 2.49) were associated with malnourished cases, and the total burden of these pathogens remained associated with malnutrition after adjusting for sociodemographic factors. The number of these pathogens at follow-up was negatively associated with the change in WAZ during the intervention (-0.10 change in WAZ per pathogen detected; 95% CI: -0.14, -0.06), whereas the number at enrollment was positively associated with the change in WAZ (0.05 change in WAZ per pathogen detected; 95% CI: 0.00, 0.10).Conclusions: A subset of enteropathogens was associated with malnutrition in this setting. Broad interventions designed to reduce the burden of infection with these pathogens are needed. This trial was registered at clinicaltrials.gov as NCT02441426.