Title
Etiology of Diarrhea, Nutritional Outcomes, and Novel Intestinal Biomarkers in Tanzanian Infants
UMMS Affiliation
Department of Pediatrics, Division of Gastroenterology and Nutrition
Publication Date
2017-1
Document Type
Article
Disciplines
Biological Factors | Dietetics and Clinical Nutrition | Digestive System Diseases | Gastroenterology | Nutrition | Pediatrics
Abstract
OBJECTIVE: Diarrheal diseases are a leading cause of morbidity and mortality worldwide, but the etiology of diarrhea and its relation to nutritional outcomes in resource-limited settings is poorly defined. We sought to determine the etiology of community-acquired diarrhea in Tanzanian infants and to assess the association with anthropometrics and novel intestinal biomarkers.
METHODS: A convenience sample of infants in a trial of zinc and/or multivitamin supplementation in Tanzania was selected. Subjects were enrolled at age 6 weeks and studied for 18 months. Stool samples were obtained from children with acute diarrhea. A novel, polymerase chain reaction-based TaqMan array was used to screen stool for 15 enteropathogens. A subset of subjects had serum gastrointestinal biomarkers measured.
RESULTS: One hundred twenty-three subjects with diarrhea were enrolled. The mean +/- SD age at stool sample collection was 12.4 +/- 3.9 months. Thirty-five enteropathogens were identified in 34 (27.6%) subjects: 11 rotavirus, 9 Cryptosporidium spp, 7 Shigella spp, 3 Campylobacter jejuni/coli, 3 heat stable-enterotoxigenic Escherichia coli, and 2 enteropathogenic E coli. Subjects with any identified enteropathogen had significantly lower weight-for-length z scores (-0.55 +/- 1.10 vs 0.03 +/- 1.30, P = 0.03) at the final clinic visit than those without an identified pathogen. Fifty of the 123 subjects (40.7%) had serum analyzed for antibodies to lipopolysaccharide (LPS) and flagellin. Subjects with any identified enteropathogen had lower immunoglobulin (IgA) antibodies to LPS (0.75 +/- 0.27 vs 1.13 +/- 0.77, P = 0.01) and flagellin (0.52 +/- 0.16 vs 0.73 +/- 0.47, P = 0.02) than those without an identified pathogen.
CONCLUSIONS: This quantitative polymerase chain reaction method may allow identification of enteropathogens that place children at higher risk for suboptimal growth. IgA anti-LPS and flagellin antibodies hold promise as emerging intestinal biomarkers.
Keywords
diarrhea, enteropathogen, intestinal biomarker, rotavirus, Tanzania, undernutrition
DOI of Published Version
10.1097/MPG.0000000000001323
Source
J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):104-108. doi: 10.1097/MPG.0000000000001323. Link to article on publisher's site
Journal/Book/Conference Title
Journal of pediatric gastroenterology and nutrition
Related Resources
PubMed ID
27347720
Repository Citation
Gosselin KB, Aboud S, McDonald CM, Moyo S, Khavari N, Manji K, Kisenge R, Fawzi W, Kellogg M, Tran HQ, Kibiki G, Gratz J, Liu J, Gewirtz A, Houpt E, Duggan C. (2017). Etiology of Diarrhea, Nutritional Outcomes, and Novel Intestinal Biomarkers in Tanzanian Infants. Pediatric Publications and Presentations. https://doi.org/10.1097/MPG.0000000000001323. Retrieved from https://escholarship.umassmed.edu/peds_pp/108