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Diarrhea as a Potential Cause and Consequence of Reduced Gut Microbial Diversity Among Undernourished Children in
Saba Rouhani1, Nicholas W Griffin2,3, Pablo Peñataro Yori1,4
1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Insights
Diarrhea significantly reduces gut bacterial diversity in children, especially those with severe stunting. A diverse gut microbiota protects against future diarrhea and promotes healthy child growth.
Area of Science:
- Microbiology
- Pediatric Health
- Nutritional Science
Background:
- Diarrhea negatively impacts child growth and survival, with mechanisms poorly understood.
- Early-life gut microbiota development is linked to growth faltering and disease susceptibility.
- This study investigates the interplay between diarrhea, gut microbiota, and child growth in the Peruvian Amazon.
Purpose of the Study:
- To assess the association between diarrhea, gut microbiota composition, and child growth.
- To determine if gut microbiota alterations are linked to diarrhea risk.
- To understand the impact of growth faltering on gut microbiota resilience.
Main Methods:
- A birth cohort of 271 children (0-24 months) was monitored monthly for growth, diarrhea, and other health factors.
- Fecal samples were collected at 6, 12, 18, and 24 months for 16S rRNA gene sequencing to analyze gut bacterial diversity and taxa.
- Statistical models were used to link diarrhea, microbiota features, and growth parameters.
Main Results:
- Diarrheal frequency, duration, and severity were negatively correlated with gut bacterial diversity and richness.
- Severely stunted children showed the most significant reductions in bacterial diversity and slower recovery post-diarrhea.
- Higher bacterial diversity predicted a lower risk of subsequent diarrhea between 6 and 18 months of age.
Conclusions:
- Severe growth faltering may impair the gut microbiota's ability to resist and recover from diarrhea.
- Reduced gut microbiota diversity and resilience increase the risk of recurrent diarrhea and further growth faltering.
- Restoring gut microbiota health is crucial for preventing childhood diarrhea and promoting optimal growth.
Background:
Detrimental effects of diarrhea on child growth and survival are well documented, but details of the underlying mechanisms remain poorly understood. Recent evidence demonstrates that perturbations to normal development of the gut microbiota in early life may contribute to growth faltering and susceptibility to related childhood diseases. We assessed associations between diarrhea, gut microbiota configuration, and childhood growth in the Peruvian Amazon.
Methods:
Growth, diarrhea incidence, illness, pathogen infection, and antibiotic exposure were assessed monthly in a birth cohort of 271 children aged 0-24 months. Gut bacterial diversity and abundances of specific bacterial taxa were quantified by sequencing 16S rRNA genes in fecal samples collected at 6, 12, 18, and 24 months. Linear and generalized linear models were used to determine whether diarrhea was associated with altered microbiota and, in turn, if features of the microbiota were associated with the subsequent risk of diarrhea.
Results:
Diarrheal frequency, duration, and severity were negatively associated with bacterial diversity and richness (P < .05). Children born stunted (length-for-age z-score [LAZ] ≤ -2) who were also severely stunted (LAZ ≤ -3) at the time of sampling exhibited the greatest degree of diarrhea-associated reductions in bacterial diversity and the slowest recovery of bacterial diversity after episodes of diarrhea. Increased bacterial diversity was predictive of reduced subsequent diarrhea from age 6 to 18 months.
Conclusions:
Persistent, severe growth faltering may reduce the gut microbiota's resistance and resilience to diarrhea, leading to greater losses of diversity and longer recovery times. This phenotype, in turn, denotes an increased risk of future diarrheal disease and growth faltering.
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