Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Nutrition Research Division, icddr,b, Dhaka, 1212, Bangladesh.
Sci Rep. 2024 Jun 15;14(1):13871. doi: 10.1038/s41598-024-64374-0.
Enteric viral pathogens are associated with a significant burden of childhood morbidity and mortality. We investigated the relationship between viral pathogens and child growth among under-5 children. We analyzed data from 5572/22,567 children enrolled in the Global Enteric Multicenter Study across seven study sites (2007-2011). Multiple linear regression was used to examine the association between the viral pathogens and changes of length/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length/height (WHZ) z-scores, stratified by diarrheal symptoms and adjusted for potential covariates. Rotavirus (18.51%) and norovirus (7.33%) were the most prevalent enteric viral pathogens among symptomatic and asymptomatic under-5 children, respectively. Infection with individual enteric viral pathogens hurts child growth in asymptomatic children. However, the relationship with HAZ was less clear and statistically non-significant. On the other hand, the combined viral pathogens demonstrated a strong negative influence on child growth [WAZ: β coef.: - 0.10 (95%, CI - 0.15, - 0.05); P < 0.001 and WHZ: β: - 0.12 (95% CI - 0.17, - 0.07); P < 0.001] among asymptomatic children. Infection with any viral pathogen was associated with growth shortfalls [HAZ: β: - 0.05 (95% CI - 0.09, 0.00); P = 0.03 and WAZ: β: - 0.11 (95% CI - 0.16, - 0.07); P < 0.001 and WHZ: β: - 0.13 (95% CI - 0.18, - 0.09); P < 0.001], though the relationship with HAZ was less evident and became statistically non-significant in older children. Notably, among symptomatic children with moderate-to-severe diarrhea, individual enteric viral pathogens, as well as the combined effects of these pathogens [WHZ: β: 0.07; (95% CI 0.01, 0.14); P = 0.03] and the presence of any virus [HAZ: β: 0.09 (95% CI 0.05, 0.13) & WAZ: β: 0.08 (95% CI 0.03, 0.12); P < 0.001], exhibited positive effects on child growth. While previous studies hypothesized that several viral pathogens had a conflicting controversial role in child growth, we find clear indications that enteric viral pathogens are associated with growth shortfalls, specifically among asymptomatic children. These findings highlight the need for preventive strategies targeting children with enteric viral pathogens, which could address the consequences of growth faltering.
肠病毒病原体与儿童发病率和死亡率有很大关系。我们研究了病毒病原体与 5 岁以下儿童生长之间的关系。我们分析了来自全球肠道多中心研究的 5572/22567 名 7 个研究地点（2007-2011 年）入组儿童的数据。采用多元线性回归分析病毒病原体与长度/身高年龄（HAZ）、体重/年龄（WAZ）和体重/长度/身高（WHZ）变化之间的关系，按腹泻症状分层，并调整潜在的混杂因素。轮状病毒（18.51%）和诺如病毒（7.33%）分别是 5 岁以下有症状和无症状儿童中最常见的肠病毒病原体。无症状儿童中，感染单一肠病毒病原体会损害儿童的生长。然而，与 HAZ 的关系不太清楚，且无统计学意义。另一方面，复合病毒病原体对无症状儿童的生长有很强的负面影响[WAZ：β系数：-0.10（95%CI-0.15，-0.05）；P<0.001和 WHZ：β：-0.12（95%CI-0.17，-0.07）；P<0.001]。任何病毒感染都与生长不足有关[HAZ：β：-0.05（95%CI-0.09，0.00）；P=0.03和 WAZ：β：-0.11（95%CI-0.16，-0.07）；P<0.001和 WHZ：β：-0.13（95%CI-0.18，-0.09）；P<0.001]，尽管与 HAZ 的关系不太明显，在年龄较大的儿童中无统计学意义。值得注意的是，在有中度至重度腹泻症状的儿童中，单一肠病毒病原体以及这些病原体的综合影响[WHZ：β：0.07（95%CI 0.01，0.14）；P=0.03]和任何病毒的存在[HAZ：β：0.09（95%CI 0.05，0.13）和 WAZ：β：0.08（95%CI 0.03，0.12）；P<0.001]，对儿童生长有积极影响。虽然之前的研究假设几种病毒病原体在儿童生长方面存在矛盾的作用，但我们发现明确的迹象表明，肠病毒病原体与生长不足有关，特别是在无症状儿童中。这些发现强调需要针对携带肠病毒病原体的儿童制定预防策略，以解决生长迟缓的后果。
