Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children.

Abstract

BACKGROUND & AIMS:

Prolonged episodes of acute diarrhea (ProD; duration 7-13 days) or persistent diarrhea (PD; duration ≥14 days) are important causes of undernutrition, yet the epidemiology and nutritional impact of ProD are poorly understood.

METHODS:

We conducted a 10-year cohort study of 414 children from a Brazilian shantytown who were followed from birth; data were collected on diarrhea, enteric pathogens, and anthropometry.

RESULTS:

During 1276 child-years of observation, we recorded 3257 diarrheal episodes. ProD was twice as common as PD (12% and 5% of episodes, respectively); ProD and PD together accounted for 50% of all days with diarrhea. ProD was more common in infants whose mothers had not completed primary school (relative risk [RR], 2.1; 95% confidence interval: 1.02-2.78). Early weaning was associated with earlier onset of ProD (Spearman ρ = 0.309; P = .005). Infants with ProD were twice as likely to develop PD in later childhood (log rank, P = .002) compared with infants with only acute diarrhea (AD; duration <7 days), even after controlling for confounders. Children's growth was more severely stunted before their first episode of ProD, compared with AD (mean height-for-age Z score (HAZ) -0.81 vs -0.51, respectively, P < .05, unpaired t test). Following ProD, HAZ (ΔHAZ = -0.232) and weight-for-age (ΔWAZ = -0.26) significantly decreased (P < .005 in paired t tests). ProD was associated with Cryptosporidium and Shigella infections.

CONCLUSIONS:

ProD accounts for significant morbidity and identifies children at risk of a vicious cycle of diarrhea and malnutrition. Further studies are needed to address the recognition and control of ProD and its consequences in resource-limited settings and assess its role in PD pathogenesis.

• Authors: Sean R Moore, Noélia L Lima, Alberto M Soares, Reinaldo B Oriá, Relana C Pinkerton, Leah J Barrett, Richard L Guerrant, Aldo A M Lima
• Journal: Gastroenterology (Gastroenterology) Vol. 139 Issue 4 Pg. 1156-64 (Oct 2010) ISSN: 1528-0012 [Electronic] United States
• PMID: 20638937 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

Topics

• Acute Disease
• Ascariasis (complications)
• Breast Feeding
• Child
• Child, Preschool
• Cohort Studies
• Diarrhea (etiology)
• Female
• Growth Disorders (etiology)
• Humans
• Infant
• Male
• Malnutrition (etiology)
• Proportional Hazards Models
• Risk
• Risk Factors