International Centre for Diarrhoeal Disease Research, Laboratory Sciences Division, Dhaka, Bangladesh.
Clin Infect Dis. 2012 Jan 15;54(2):185-92. doi: 10.1093/cid/cir807. Epub 2011 Nov 21.
Malnourished children are at increased risk for death due to diarrhea. Our goal was to determine the contribution of specific enteric infections to malnutrition-associated diarrhea and to determine the role of enteric infections in the development of malnutrition.
Children from an urban slum in Bangladesh were followed for the first year of life by every-other-day home visits. Enteropathogens were identified in diarrheal and monthly surveillance stools; intestinal barrier function was measured by serum endocab antibodies; and nutritional status was measured by anthropometry.
Diarrhea occurred 4.69 ± 0.19 times per child per year, with the most common infections caused by enteric protozoa (amebiasis, cryptosporidiosis, and giardiasis), rotavirus, astrovirus, and enterotoxigenic Escherichia coli (ETEC). Malnutrition was present in 16.3% of children at birth and 42.4% at 12 months of age. Children malnourished at birth had increased Entamoeba histolytica, Cryptosporidium, and ETEC infections and more severe diarrhea. Children who became malnourished by 12 months of age were more likely to have prolonged diarrhea, intestinal barrier dysfunction, a mother without education, and low family expenditure.
Prospective observation of infants in an urban slum demonstrated that diarrheal diseases were associated with the development of malnutrition that was in turn linked to intestinal barrier disruption and that diarrhea was more severe in already malnourished children. The enteric protozoa were unexpectedly important causes of diarrhea in this setting. This study demonstrates the complex interrelationship of malnutrition and diarrhea in infants in low-income settings and points to the potential for infectious disease interventions in the prevention and treatment of malnutrition.
营养不良的儿童因腹泻而死亡的风险增加。我们的目标是确定特定的肠道感染对营养不良相关腹泻的贡献，并确定肠道感染在营养不良发展中的作用。
孟加拉国一个城市贫民窟的儿童在生命的第一年通过每隔一天的家访进行跟踪。在腹泻和每月监测粪便中确定肠道病原体；通过血清内毒素抗体测量肠道屏障功能；通过人体测量学测量营养状况。
每个儿童每年腹泻 4.69 ± 0.19 次，最常见的感染是肠道原生动物（阿米巴病、隐孢子虫病和贾第虫病）、轮状病毒、星状病毒和肠毒性大肠杆菌（ETEC）引起的。出生时营养不良的儿童占 16.3%，12 个月时营养不良的儿童占 42.4%。出生时营养不良的儿童有更多的 Entamoeba histolytica、Cryptosporidium 和 ETEC 感染，腹泻更严重。到 12 个月时变得营养不良的儿童更有可能出现持续时间较长的腹泻、肠道屏障功能障碍、母亲没有受过教育和家庭支出较低。
对城市贫民窟婴儿的前瞻性观察表明，腹泻病与营养不良的发展有关，而营养不良又与肠道屏障破坏有关，并且已经营养不良的儿童腹泻更严重。在这种情况下，肠道原生动物是腹泻的意外重要原因。本研究证明了低收入环境中婴儿营养不良和腹泻之间的复杂相互关系，并指出传染病干预在预防和治疗营养不良方面具有潜力。
