Division of Pediatric Infectious Diseases, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA.
Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
Am J Gastroenterol. 2022 Jan 1;117(1):167-175. doi: 10.14309/ajg.0000000000001535.
Small intestine bacterial overgrowth (SIBO) is common in children from low-income countries and has been cross-sectionally associated with growth stunting. We sought to determine whether SIBO was associated with poor growth and neurodevelopmental in a longitudinal analysis.
We measured SIBO by glucose hydrogen breath test (GHBT) at 18, 52, 78, and 104 weeks of life in a prospective longitudinal birth cohort of Bangladeshi children. Sociodemographic information and measures of enteric inflammation were analyzed as covariates. Diarrheal samples were tested for enteropathogens using polymerase chain reaction. Regression models were created using standardized mean GHBT area under the H2 curve (AUC) to determine associations with linear growth and cognitive, language, and motor scores on the Bayley-III Scales of Infant and Toddler Development at 2 years. We also investigated associations between GHBT AUC and enteropathogen exposure.
A 1-ppm increase in standardized mean GHBT AUC was associated with a 0.01-SD decrease in length-for-age Z score (P = 0.03) and a 0.11-point decrease in Bayley language score (P = 0.05) at 2 years of age in adjusted analysis. Enteroaggregative Escherichia coli, Enteropathogenic Escherichia coli, Giardia, and Enterocytozoon bieneusi were associated with increased GHBT AUC, whereas Clostridium difficile, norovirus GI, sapovirus, rotavirus, and Cryptosporidium were associated with decreased GHBT AUC. None were consistent across all 4 time points.
SIBO in the first 2 years of life is associated with growth stunting and decreased language ability in Bangladeshi infants and may represent a modifiable risk factor in poor growth and neurodevelopment in low-income countries.
小肠细菌过度生长（SIBO）在低收入国家的儿童中很常见，并且与生长迟缓呈横断面相关。我们旨在通过纵向分析来确定 SIBO 是否与不良生长和神经发育有关。
我们在孟加拉国儿童的前瞻性纵向出生队列中，在 18、52、78 和 104 周龄时通过葡萄糖氢呼气试验（GHBT）测量 SIBO。社会人口统计学信息和肠内炎症指标被分析为协变量。使用聚合酶链反应测试腹泻样本中的肠道病原体。使用标准化平均 GHBT H2 曲线下面积（AUC）的回归模型来确定与 2 岁时贝利婴幼儿发育量表的线性生长以及认知、语言和运动评分的关联。我们还研究了 GHBT AUC 与肠道病原体暴露之间的关联。
在调整后的分析中，标准化平均 GHBT AUC 每增加 1 ppm，与年龄身高 Z 评分降低 0.01 个标准差（P = 0.03）和贝利语言评分降低 0.11 分（P = 0.05）相关。肠聚集性大肠杆菌、肠致病性大肠杆菌、贾第虫和肠上皮细胞内原生动物与 GHBT AUC 增加有关，而艰难梭菌、诺如病毒 GI、沙波病毒、轮状病毒和隐孢子虫与 GHBT AUC 降低有关。这些关联在所有 4 个时间点都不一致。
生命的头 2 年的 SIBO 与孟加拉国婴儿的生长迟缓以及语言能力下降有关，并且可能代表了低收入国家不良生长和神经发育的可改变的危险因素。
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