Lima Aldo A M, Leite Álvaro M, Di Moura Alessandra, Lima Noélia L, Soares Alberto M, Abreu Cláudia B, Filho José Quirino, Mota Rosa M S, Lima Ila F N, Havt Alexandre, Medeiros Pedro H Q S, Prata Mara M G, Guedes Marjorie M, Cavalcante Paloma A, Veras Herlice N, Santos Ana K S, Moore Sean R, Pinkerton Relana C, Houpt Eric R, Guerrant Richard L
From the *Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, †Department of Pediatric, Institute for the Promotion of Nutrition and Human Development, and ‡Department of Statistics and Applied Mathematics, Federal University of Ceará, Fortaleza, Ceará, Brazil; §Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio; and ¶Department of Medicine, Center for Global Health and Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia.
Pediatr Infect Dis J. 2017 Dec;36(12):1177-1185. doi: 10.1097/INF.0000000000001569.
Malnutrition results in serious consequences for growth and cognitive development in children. We studied select child and maternal biologic factors, socioeconomic factors, enteric pathogenic burden and gut function biomarkers in 402 children 6-24 months of age in Northeastern Brazil. In this prospective case-control study, not being fed colostrum [odds ratio (OR): 3.29, 95% confidence interval (CI): 1.73-6.26], maternal age ≥18 years (OR: 1.88, 95% CI: 1.10-3.22) and no electric fan (OR: 2.46, 95% CI: 1.22-4.96) or bicycle (OR: 1.80, 95% CI: 1.10-2.95) in the household were positively associated, and higher birth weight (OR: 0.27, 95% CI: 0.19-0.38), larger head circumference (OR: 0.74, 95% CI: 0.66-0.82) and shortness of breath in the last 2 weeks (OR: 0.49, 95% CI: 0.27-0.90) were negatively associated with malnutrition. Subclinical enteric pathogen infections were common, and enteroaggregative Escherichia coli infections were more prevalent in malnourished children (P = 0.045). Biomarkers such as the lactulose-mannitol test, myeloperoxidase, neopterin and calprotectin were highly elevated in both malnourished and nourished children. Nourished children had a better systemic immune response than the malnourished children, as detected by elevated serum amyloid A-1 and soluble cluster of differentiation protein 14 biomarkers (P < 0.001). Serum amyloid A-1 and soluble cluster of differentiation protein 14 were also associated with better nutritional Z scores. Neonatal, maternal and socioeconomic factors were associated with malnutrition in children. There was a substantial subclinical enteric pathogen burden, particularly with enteroaggregative E. coli, in malnourished children.
营养不良会给儿童的生长发育和认知发展带来严重后果。我们对巴西东北部402名6至24个月大的儿童的特定儿童和母亲生物学因素、社会经济因素、肠道致病负担和肠道功能生物标志物进行了研究。在这项前瞻性病例对照研究中，未喂养初乳（比值比[OR]：3.29，95%置信区间[CI]：1.73 - 6.26）、母亲年龄≥18岁（OR：1.88，95%CI：1.10 - 3.22）以及家中没有电风扇（OR：2.46，95%CI：1.22 - 4.96）或自行车（OR：1.80，95%CI：1.10 - 2.95）与营养不良呈正相关，而较高的出生体重（OR：0.27，95%CI：0.19 - 0.38）、较大的头围（OR：0.74，95%CI：0.66 - 0.82）以及过去2周内呼吸急促（OR：0.49，95%CI：0.27 - 0.90）与营养不良呈负相关。亚临床肠道病原体感染很常见，且肠聚集性大肠杆菌感染在营养不良儿童中更为普遍（P = 0.045）。乳果糖 - 甘露醇试验、髓过氧化物酶、新蝶呤和钙卫蛋白等生物标志物在营养不良和营养良好的儿童中均显著升高。通过血清淀粉样蛋白A - 1和可溶性分化簇蛋白14生物标志物升高检测发现，营养良好的儿童比营养不良的儿童具有更好的全身免疫反应（P < 0.001）。血清淀粉样蛋白A - 1和可溶性分化簇蛋白14也与更好的营养Z评分相关。新生儿、母亲和社会经济因素与儿童营养不良有关。营养不良儿童存在大量亚临床肠道病原体负担，尤其是肠聚集性大肠杆菌。
