Fecal Markers of Environmental Enteropathy Are Associated with Animal Exposure and Caregiver Hygiene in Bangladesh
Fecal Markers of Environmental Enteropathy Are Associated with Animal Exposure and Caregiver Hygiene in Bangladesh
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DOI：
10.4269/ajtmh.14-0694
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发表时间：
2015-08-01
影响因子：
3.3
通讯作者：
Faruque, Abu G.
中科院分区：
文献类型：
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作者：
George, Christine Marie;Oldja, Lauren;Faruque, Abu G.
据估计，营养不良是全球一半以上幼儿死亡的根本原因。越来越多的文献表明，接触肠道病原体的增加是环境性肠病（EE）的原因，这是一种与儿童生长受损相关的疾病。为了确定家庭不卫生的环境条件是否与儿童情感表达和发育迟缓显著相关，我们在孟加拉国农村对216名30个月大的儿童进行了队列研究。分析粪便中EE的四种粪便标志物：α -1 -抗胰蛋白酶、髓过氧化物酶、联合形成EE疾病活动评分的新蝶呤和钙保护蛋白。我们观察到，在调整潜在混杂因素后，在儿童卧室设置畜栏与情感表达得分升高（1.0分差，95%置信区间[CI]: 0.13, L88）之间存在显著关联，发育迟缓（身高年龄比值z-score < -2）的几率高出两倍（比值比[OR]: 2.53, 95% Cl: 1.08, 5.43）。此外，手明显脏的照顾者的儿童粪便钙保护蛋白（mu g/g）显著升高（384.1,95% Cl: 152.37, 615.83）。这些发现表明，与动物的密切接触和照顾者的卫生可能是幼儿情感表达的重要危险因素。这些发现与假设一致，即不卫生的环境条件可导致易受影响的儿科人群发生情感表达。
Undernutrition is estimated to be an underlying cause of over half of all deaths in young children globally. There is a growing body of literature suggesting that increased exposure to enteric pathogens is responsible for environmental enteropathy (EE), a disorder associated with impaired growth in children. To determine if household unsanitary environmental conditions were significantly associated with EE and stunting in children, we conducted a cohort of 216 children 30 months) in rural Bangladesh. Stool was analyzed for four fecal markers of EE: alpha-1 -antitrypsin, myeloperoxidase, and neopterin combined to form an EE disease activity score, and calprotectin. We observed a significant association between having an animal corral in a child's sleeping room and elevated EE scores (1.0 point difference, 95% confidence interval [CI]: 0.13, L88) and a two times higher odds of stunting (height-for-age z-score < -2) (odds ratio [OR]: 2.53, 95% Cl: 1.08, 5.43) after adjusting for potential confounders. In addition, children of caregivers with visibly soiled hands had significantly elevated fecal calprotectin (mu g/g) (384.1, 95% Cl: 152.37, 615.83). These findings suggest that close contact with animals and caregiver hygiene may be important risk factors for EE in young children. These findings are consistent with the hypothesis that unsanitary environmental conditions can lead to EE in susceptible pediatric populations.