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

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.