Niehaus Mark D, Moore Sean R, Patrick Peter D, Derr Lori L, Lorntz Breyette, Lima Aldo A, Guerrant Richard L
Brown University, Providence, Rhode Island, USA.
Am J Trop Med Hyg. 2002 May;66(5):590-3. doi: 10.4269/ajtmh.2002.66.590.
Diarrhea is well recognized as a leading cause of childhood mortality and morbidity in developing countries; however, possible long-term cognitive deficits from heavy diarrhea burdens in early childhood remain poorly defined. To assess the potential long-term impact of early childhood diarrhea (in the first 2 years of life) on cognitive function in later childhood, we studied the cognitive function of a cohort of children in an urban Brazilian shantytown with a high incidence of early childhood diarrhea. Forty-six children (age range, 6-10 years) with complete diarrhea surveillance during their first 2 years of life were given a battery of five cognitive tests. Test of Non-Verbal Intelligence-III (TONI) scores were inversely correlated with early childhood diarrhea (P = .01), even when controlling for maternal education, duration of breast-feeding, and early childhood helminthiasis (Ascaris or Trichuris). Furthermore, Wechsler Intelligence Scale for Children (WISC-III) Coding Tasks and WISC-III Digit Span (reverse and total) scores were also significantly lower in the 17 children with a history of early childhood persistent diarrhea (PD; P < .05), even when controlling for helminths and maternal education. No correlations were seen between diarrhea rates and Wide Range Assessment of Memory and Learning subtests or WISC-III Mazes. This report (with larger numbers of participants and new tests) confirms and substantially extends previous pilot studies, showing that long-term cognitive deficits are associated with early childhood diarrhea. These findings have important implications for the importance of interventions that may reduce early childhood diarrheal illnesses or their consequences.
腹泻是发展中国家儿童死亡和发病的主要原因，这一点已得到广泛认可；然而，幼儿期严重腹泻负担可能导致的长期认知缺陷仍未明确界定。为了评估幼儿期腹泻（出生后头两年）对儿童后期认知功能的潜在长期影响，我们对巴西一个城市棚户区中幼儿腹泻发病率较高的一组儿童的认知功能进行了研究。对46名在出生后头两年有完整腹泻监测记录的儿童（年龄范围6 - 10岁）进行了一系列五项认知测试。即使在控制了母亲教育程度、母乳喂养时间和幼儿期蠕虫感染（蛔虫或鞭虫）后，非言语智力测试第三版（TONI）得分仍与幼儿期腹泻呈负相关（P = 0.01）。此外，在17名有幼儿期持续性腹泻（PD）病史的儿童中，韦氏儿童智力量表第三版（WISC - III）编码任务和WISC - III数字广度（倒序和总分）得分也显著较低（P < 0.05），即使在控制了蠕虫感染和母亲教育程度之后。腹泻发生率与记忆和学习广度评估子测试或WISC - III迷宫测试之间未发现相关性。本报告（纳入了更多参与者并采用了新测试）证实并大幅扩展了先前的试点研究，表明长期认知缺陷与幼儿期腹泻有关。这些发现对于可能减少幼儿期腹泻疾病或其后果的干预措施的重要性具有重要意义。
