Pinkerton Relana, Oriá Reinaldo B, Lima Aldo A M, Rogawski Elizabeth T, Oriá Mônica O B, Patrick Peter D, Moore Sean R, Wiseman Benjamin L, Niehaus Mark D, Guerrant Richard L
Center for Global Health, Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, Virginia.
Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Am J Trop Med Hyg. 2016 Nov 2;95(5):1004-1010. doi: 10.4269/ajtmh.16-0150. Epub 2016 Sep 6.
Understanding the complex relationship between early childhood infectious diseases, nutritional status, poverty, and cognitive development is significantly hindered by the lack of studies that adequately address confounding between these variables. This study assesses the independent contributions of early childhood diarrhea (ECD) and malnutrition on cognitive impairment in later childhood. A cohort of 131 children from a shantytown community in northeast Brazil was monitored from birth to 24 months for diarrhea and anthropometric status. Cognitive assessments including Test of Nonverbal Intelligence (TONI), coding tasks (WISC-III), and verbal fluency (NEPSY) were completed when children were an average of 8.4 years of age (range = 5.6-12.7 years). Multivariate analysis of variance models were used to assess the individual as well as combined effects of ECD and stunting on later childhood cognitive performance. ECD, height for age (HAZ) at 24 months, and weight for age (WAZ) at 24 months were significant univariate predictors of the studies three cognitive outcomes: TONI, coding, and verbal performance (P < 0.05). Multivariate models showed that ECD remained a significant predictor, after adjusting for the effect of 24 months HAZ and WAZ, for both TONI (HAZ, P = 0.029 and WAZ, P = 0.006) and coding (HAZ, P = 0.025 and WAZ, P = 0.036) scores. WAZ and HAZ were also significant predictors after adjusting for ECD. ECD remained a significant predictor of coding (WISC III) after number of household income was considered (P = 0.006). This study provides evidence that ECD and stunting may have independent effects on children's intellectual function well into later childhood.
由于缺乏充分解决这些变量之间混杂因素的研究，理解幼儿传染病、营养状况、贫困和认知发展之间的复杂关系受到了显著阻碍。本研究评估了幼儿腹泻（ECD）和营养不良对儿童后期认知障碍的独立影响。对来自巴西东北部一个棚户区社区的131名儿童进行队列研究，从出生到24个月监测其腹泻情况和人体测量状况。当儿童平均年龄为8.4岁（范围 = 5.6 - 12.7岁）时，完成包括非言语智力测试（TONI）、编码任务（WISC - III）和言语流畅性（NEPSY）在内的认知评估。使用多变量方差分析模型评估ECD和发育迟缓对儿童后期认知表现的个体及综合影响。ECD、24个月时的年龄别身高（HAZ）和年龄别体重（WAZ）是该研究三项认知结果（TONI、编码和言语表现）的显著单变量预测因素（P < 0.05）。多变量模型显示，在调整24个月HAZ和WAZ的影响后，ECD仍然是TONI（HAZ，P = 0.029；WAZ，P = 0.006）和编码（HAZ，P = 0.025；WAZ，P = 0.036）分数的显著预测因素。在调整ECD后，WAZ和HAZ也是显著预测因素。在考虑家庭收入数量后，ECD仍然是编码（WISC III）的显著预测因素（P = 0.006）。本研究提供了证据表明，ECD和发育迟缓可能对儿童后期的智力功能产生独立影响。
