Association between enteropathogens and malnutrition in children aged 6-23 mo in Bangladesh: a case-control study
Association between enteropathogens and malnutrition in children aged 6-23 mo in Bangladesh: a case-control study
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DOI：
10.3945/ajcn.116.138800
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发表时间：
2017-05-01
影响因子：
7.1
通讯作者：
Ahmed, Tahmeed
中科院分区：
文献类型：
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作者：
Platts-Mills, James A.;Taniuchi, Mami;Ahmed, Tahmeed
背景：在低资源环境中，早期暴露于肠道病原体与儿童营养不良有关。然而，单个肠道病原体的贡献仍然很难定义。分子诊断提供了检测肠道病原体的灵敏度增加，但尚未全面应用于营养不良的研究。目的：我们试图确定孟加拉国与营养不良相关的肠道病原体。设计：孟加拉国达卡6-23个月的营养不良儿童[年龄别体重z评分（WAZ）< - 2]，经积极的社区监测确定为病例，对照组为来自同一社区的同龄正常体重儿童（WAZ >-1）。在入组时收集粪便，对于病例，在5个月的营养干预后收集粪便。招募和随访粪便进行了测试，通过定量聚合酶链反应与定制开发的TaqMan阵列Card.Results的使用32肠道病原体：肠道病原体检测进行了486例和442例对照后，招募和365例随访。在入组时，肠聚集性大肠埃希菌（OR：1.39; 95% CI：1.05，1.83）、弯曲杆菌属的检测。(OR：1.46; 95% CI：1.11，1.91），产热不稳定肠毒素E.大肠埃希菌（OR：1.55; 95% CI：1.04，2.33）、志贺菌/肠侵袭性大肠埃希菌（OR：1.55; 95% CI：1.04，2.33）。大肠杆菌（OR：1.65; 95%可信区间：诺如病毒基因组I（OR：1.66; 95%CI：1.23，2.25）和贾第虫（OR：1.73; 95%CI：1.20，2.49）与营养不良病例相关，调整社会人口因素后，这些病原体的总负担仍与营养不良相关。随访时这些病原体的数量与干预期间WAZ的变化呈负相关（每检测到一种病原体，WAZ的变化为20.10; 95% CI：-0.14，-0.06），而入组时的数量与WAZ的变化呈正相关（每检测到一种病原体，WAZ的变化为0.05; 95%CI：0.00，0.10）。结论：在这种情况下，肠道病原体的一个子集与营养不良有关。需要采取广泛的干预措施，以减少这些病原体的感染负担。
Background: Early exposure to enteropathogens has been associated with malnutrition in children in low-resource settings. However, the contribution of individual enteropathogens remains poorly defined. Molecular diagnostics offer an increase in sensitivity for detecting enteropathogens but have not been comprehensively applied to studies of malnutrition.Objective: We sought to identify enteropathogens associated with malnutrition in Bangladesh.Design: Malnourished children [weight-for-age z score (WAZ) < - 2] aged 6-23 mo in Dhaka, Bangladesh, and identified by active community surveillance were enrolled as cases, and normalweight children (WAZ > - 1) of the same age and from the same community were enrolled as controls. Stools were collected at enrollment and, for cases, after a 5-mo nutritional intervention. Enrollment and follow-up stools were tested by quantitative polymerase chain reaction for 32 enteropathogens with the use of a custom-developed TaqMan Array Card.Results: Enteropathogen testing was performed on 486 cases and 442 controls upon enrollment and 365 cases at follow-up. At enrollment, the detection of enteroaggregative Escherichia coli (OR: 1.39; 95% CI: 1.05, 1.83), Campylobacter spp. (OR: 1.46; 95% CI: 1.11, 1.91), heat-labile enterotoxin-producing E. coli (OR: 1.55; 95% CI: 1.04, 2.33), Shigella/enteroinvasive E. coli (OR: 1.65; 95% CI: 1.10, 2.46), norovirus genogroup I (OR: 1.66; 95% CI: 1.23, 2.25), and Giardia (OR: 1.73; 95% CI: 1.20, 2.49) were associated with malnourished cases, and the total burden of these pathogens remained associated with malnutrition after adjusting for sociodemographic factors. The number of these pathogens at follow-up was negatively associated with the change in WAZ during the intervention (20.10 change in WAZ per pathogen detected; 95% CI: -0.14, -0.06), whereas the number at enrollment was positively associated with the change in WAZ (0.05 change in WAZ per pathogen detected; 95% CI: 0.00, 0.10).Conclusions: A subset of enteropathogens was associated with malnutrition in this setting. Broad interventions designed to reduce the burden of infection with these pathogens are needed.