A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea.
A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea.
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DOI：
10.1093/cid/ciw391
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发表时间：
2016-09-15
期刊：
影响因子：
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通讯作者：
Petri WA Jr
中科院分区：
文献类型：
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作者：
Donowitz JR;Alam M;Kabir M;Ma JZ;Nazib F;Platts-Mills JA;Bartelt LA;Haque R;Petri WA Jr
这项前瞻性纵向出生队列研究表明，出生后前6个月无症状贾第虫病是线性生长不良的危险因素。此外，无症状贾第虫病既不增加也不减少发生全因急性腹泻发作的几率。背景。在低收入国家，两岁以下儿童的生长发育迟缓很常见。贾第鞭毛虫是这一年龄组普遍存在的病原体，但调查贾第鞭毛虫对生长和腹泻的影响的研究产生了相互矛盾的结果。方法。我们在孟加拉国达卡进行了一项前瞻性纵向出生队列研究，每月进行贾第鞭毛虫和连续腹泻监测。结果。629名儿童在出生后72小时内被纳入研究，其中445名完成了2年的研究。12%的儿童在出生时发育迟缓，57%的儿童在两岁时发育迟缓。7%的儿童在出生后前6个月大便呈贾第鞭毛虫阳性，而74%的儿童在2岁前大便呈阳性。首次贾第鞭毛虫阳性监测大便的中位时间为17个月。出生后6个月内每月监测粪便中存在贾第鞭毛虫，使2岁时年龄长度Z评分下降0.4(95%可信区间，−。80 ~−.001；P值。2005年)，而在2年的观察期间，贾第鞭毛虫阳性月份的总数没有变化。这两个变量都与2岁时的体重/年龄Z评分无关。在我们检验腹泻预测因子的模型中，纯母乳喂养与腹泻减少显著相关（P值< 0.001）。伴发贾第虫病既不是危险因素，也不是保护因素。结论。贾第鞭毛虫是2岁发育迟缓的危险因素，但不是体重增加不佳的危险因素。贾第鞭毛虫的存在既没有增加也没有减少急性全因腹泻的几率。
This prospective longitudinal birth cohort demonstrated that asymptomatic giardiasis in the first 6 months of life is a risk factor for poor linear growth. Furthermore, asymptomatic giardiasis neither increases nor decreases odds of having an all cause acute diarrheal episode. Background. Growth stunting in children under 2 years of age in low-income countries is common. Giardia is a ubiquitous pathogen in this age group but studies investigating Giardia's effect on both growth and diarrhea have produced conflicting results. Methods. We conducted a prospective longitudinal birth cohort study in Dhaka, Bangladesh, with monthly Giardia and continuous diarrheal surveillance. Results. 629 children were enrolled within the first 72 hours of life, and 445 completed 2 years of the study. 12% of children were stunted at birth with 57% stunted by 2 years. 7% of children had a Giardia positive surveillance stool in the first 6 months of life, whereas 74% had a positive stool by 2 years. The median time to first Giardia positive surveillance stool was 17 months. Presence of Giardia in a monthly surveillance stool within the first 6 months of life decreased length-for-age Z score at 2 years by 0.4 (95% confidence interval, −.80 to −.001; P value .05) whereas total number of Giardia positive months over the 2-year period of observation did not. Neither variable was associated with weight-for-age Z score at 2 years. In our model to examine predictors of diarrhea only exclusive breastfeeding was significantly associated with decreased diarrhea (P value <.001). Concomitant giardiasis was neither a risk factor nor protective. Conclusions. Early life Giardia was a risk factor for stunting at age 2 but not poor weight gain. Presence of Giardia neither increased nor decreased odds of acute all cause diarrhea.