Childhood
diarrhea in low-resource settings has been variably linked to linear growth shortfalls. However, the association between etiology-specific
diarrhea and growth has not been comprehensively evaluated. We tested diarrheal stools collected from the Performance of Rotavirus and Oral
Polio Vaccines in Developing Countries study from 2011 to 2013 in Dhaka, Bangladesh, by quantitative polymerase chain reaction for a broad range of enteropathogens to characterize
diarrhea etiology and examine the association between etiology-specific
diarrhea and linear growth and systemic
inflammation. Pathogen-specific burdens of
diarrhea were determined using attributable fractions. Linear regression was used to examine associations of pathogen-specific
diarrhea with length-for-age z scores (LAZ) and serum
C-reactive protein. There was no relationship between all-cause
diarrhea and length at 12 months (change in 12-month LAZ per episode, -0.01, 95% confidence interval (CI): -0.06, 0.03). However, Cryptosporidium (change in 12-month LAZ per attributable episode, -0.23, 95% CI: -0.50, 0.03), Campylobacter jejuni/coli (change of -0.16, 95% CI: -0.32, -0.01), and Shigella/enteroinvasive Escherichia coli
diarrhea (change of -0.12, 95% CI: -0.26, 0.03) were associated with linear growth deficits.
Diarrhea attributable to C. jejuni/coli and Shigella/enteroinvasive E. coli were associated with elevated
C-reactive protein. The association between
diarrhea and linear growth appears to be pathogen-specific, reinforcing the need for pathogen-specific interventions.