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Small Intestine Bacterial Overgrowth in Bangladeshi Infants Is Associated With Growth Stunting in a Longitudinal
Jeffrey R Donowitz1,2, Zhen Pu3, Ye Lin3
1Division of Pediatric Infectious Diseases, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA.
Insights
Small intestine bacterial overgrowth (SIBO) in infants is linked to stunted growth and lower language scores. Addressing SIBO may improve child development in low-income countries.
Area of Science:
- Pediatric Gastroenterology
- Global Child Health
- Developmental Pediatrics
Background:
- Small intestine bacterial overgrowth (SIBO) is prevalent in low-income countries and linked to growth stunting.
- Longitudinal data on SIBO's impact on child growth and neurodevelopment is limited.
Purpose of the Study:
- To investigate the longitudinal association between SIBO and growth and neurodevelopment in Bangladeshi infants.
- To explore the relationship between SIBO and enteropathogen exposure.
Main Methods:
- Prospective birth cohort study of Bangladeshi children.
- SIBO measured using glucose hydrogen breath test (GHBT) at multiple time points.
- Linear growth and neurodevelopment (cognitive, language, motor) assessed at 2 years; enteropathogens identified via PCR.
Main Results:
- Increased GHBT AUC (SIBO marker) associated with decreased length-for-age Z score and lower Bayley language scores at 2 years.
- Specific enteropathogens (e.g., E. coli, Giardia) linked to higher GHBT AUC; others (e.g., Rotavirus, Norovirus) linked to lower GHBT AUC.
- No enteropathogen association was consistent across all four measurement time points.
Conclusions:
- SIBO in early childhood is associated with impaired growth and language development in this cohort.
- SIBO represents a potential modifiable risk factor for poor growth and neurodevelopment in resource-limited settings.
Introduction:
Small intestine bacterial overgrowth (SIBO) is common in children from low-income countries and has been cross-sectionally associated with growth stunting. We sought to determine whether SIBO was associated with poor growth and neurodevelopmental in a longitudinal analysis.
Methods:
We measured SIBO by glucose hydrogen breath test (GHBT) at 18, 52, 78, and 104 weeks of life in a prospective longitudinal birth cohort of Bangladeshi children. Sociodemographic information and measures of enteric inflammation were analyzed as covariates. Diarrheal samples were tested for enteropathogens using polymerase chain reaction. Regression models were created using standardized mean GHBT area under the H2 curve (AUC) to determine associations with linear growth and cognitive, language, and motor scores on the Bayley-III Scales of Infant and Toddler Development at 2 years. We also investigated associations between GHBT AUC and enteropathogen exposure.
Results:
A 1-ppm increase in standardized mean GHBT AUC was associated with a 0.01-SD decrease in length-for-age Z score (P = 0.03) and a 0.11-point decrease in Bayley language score (P = 0.05) at 2 years of age in adjusted analysis. Enteroaggregative Escherichia coli, Enteropathogenic Escherichia coli, Giardia, and Enterocytozoon bieneusi were associated with increased GHBT AUC, whereas Clostridium difficile, norovirus GI, sapovirus, rotavirus, and Cryptosporidium were associated with decreased GHBT AUC. None were consistent across all 4 time points.
Discussion:
SIBO in the first 2 years of life is associated with growth stunting and decreased language ability in Bangladeshi infants and may represent a modifiable risk factor in poor growth and neurodevelopment in low-income countries.
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