Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
PLoS Negl Trop Dis. 2023 Oct 10;17(10):e0011687. doi: 10.1371/journal.pntd.0011687. eCollection 2023 Oct.
Entamoeba histolytica, Giardia, and Cryptosporidium are common intestinal protozoan parasites that contribute to a high burden of childhood morbidity and mortality. Our study quantified the association between intestinal protozoan parasites and child anthropometric outcomes among children under-5.
We analyzed data from 7,800 children enrolled in the Global Enteric Multicenter Study (GEMS) across seven study sites that were positive for intestinal protozoan parasites between December 2007 and March 2011. Parasites were assessed using stool immunoassays (ELISA). We applied multiple linear regression to test the association between any or concurrent parasite and child anthropometric outcomes: length/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length/height (WHZ) z-score after 60 days of enrollment. Models were stratified by diarrheal symptoms, driven by the study design, and adjusted for potential covariates.
During the follow-up at day 60 after enrollment, child anthropometric outcomes, among the asymptomatic children showed, negative associations between Giardia with HAZ [β: -0.13; 95% CI: -0.17, -0.09; p<0.001] and WAZ [β -0.07; 95% CI: -0.11, -0.04; p<0.001], but not WHZ [β: -0.02; 95% CI:-0.06, 0.02; p = 0.36]; Cryptosporidium with WAZ [β: -0.15; 95% CI: -0.22, -0.09; p<0.001] and WHZ [β: -0.18; 95%CI: -0.25, -0.12; p<0.001], but not with HAZ [β: -0.03; 95% CI: -0.09, 0.04; p = 0.40]. For symptomatic children, no associations were found between Giardia and anthropometry; negative associations were found between Cryptosporidium with HAZ [β: -0.17; 95% CI: -0.23, -0.11; p<0.001], WAZ [β: -0.25; 95% CI: -0.31, -0.19; p<0.001] and WHZ [β: -0.23; 95% CI: -0.30, -0.17; p<0.001]. Among the asymptomatic 24-59 months children, Giardia had a negative association with HAZ [β: -0.09; 95% CI: -0.15, -0.04; p = 0.001]. No significant associations were found between E. histolytica with child growth.
While some studies have found that Giardia is not associated with (or protective against) acute diarrhea, our findings suggest that it is associated with growth shortfall. This observation underscores the need for preventive strategies targeting enteric protozoan parasites among young children, to reduce the burden of childhood malnutrition.
溶组织内阿米巴原虫、贾第鞭毛虫和隐孢子虫是常见的肠道原生动物寄生虫，它们是导致儿童发病率和死亡率高的主要原因之一。我们的研究定量评估了肠道原生动物寄生虫与 5 岁以下儿童人体测量学结局之间的关系。
我们分析了 2007 年 12 月至 2011 年 3 月期间在全球肠道多中心研究（GEMS）中 7800 名被诊断为肠道原生动物寄生虫阳性的儿童的数据。寄生虫使用粪便免疫测定（ELISA）进行评估。我们应用多元线性回归来检验任何寄生虫或同时存在寄生虫与儿童人体测量学结局之间的关系：登记后 60 天的身长/身高年龄（HAZ）、体重/年龄（WAZ）和体重/身长/身高（WHZ）z 分数。由于研究设计，根据腹泻症状对模型进行分层，并调整了潜在的混杂因素。
在登记后 60 天的随访期间，无症状儿童的人体测量学结局显示，贾第鞭毛虫与 HAZ [β：-0.13；95%CI：-0.17，-0.09；p<0.001]和 WAZ [β：-0.07；95%CI：-0.11，-0.04；p<0.001]呈负相关，但与 WHZ [β：-0.02；95%CI：-0.06，0.02；p = 0.36]无关；隐孢子虫与 WAZ [β：-0.15；95%CI：-0.22，-0.09；p<0.001]和 WHZ [β：-0.18；95%CI：-0.25，-0.12；p<0.001]呈负相关，但与 HAZ [β：-0.03；95%CI：-0.09，0.04；p = 0.40]无关。对于有症状的儿童，贾第鞭毛虫与人体测量学之间没有发现任何关联；隐孢子虫与 HAZ [β：-0.17；95%CI：-0.23，-0.11；p<0.001]、WAZ [β：-0.25；95%CI：-0.31，-0.19；p<0.001]和 WHZ [β：-0.23；95%CI：-0.30，-0.17；p<0.001]呈负相关。在无症状的 24-59 个月儿童中，贾第鞭毛虫与 HAZ 呈负相关 [β：-0.09；95%CI：-0.15，-0.04；p = 0.001]。溶组织内阿米巴原虫与儿童生长之间没有发现显著的关联。
虽然一些研究发现贾第鞭毛虫与急性腹泻无关（或有保护作用），但我们的研究结果表明，它与生长不足有关。这一观察结果强调了需要针对幼儿肠道原生动物寄生虫制定预防策略，以减少儿童营养不良的负担。
