Proportional hazards analysis of diarrhea due to enterotoxigenic Escherichia coli and breast feeding in a cohort of urban Mexican children.
Ninety-eight women-infant pairs were followed for up to 50 weeks in the northern part of Guadalajara, Mexico, from August 1986 to July 1987 as part of a community-based, prospective study of the relation between infant feeding patterns and enterotoxigenic Escherichia coli producing heat-labile toxin (LT-ETEC) diarrheal disease. Strictly formula-fed children had an incidence of diarrhea over three times that of strictly breast-fed infants and twice that of breast-fed and supplementally fed children. Strictly formula-fed infants colonized by LT-ETEC were symptomatic for diarrhea nearly three times as often as strictly breast-fed infants and twice as often as infants receiving a mixed diet. The fitting of parametric hazard models to durations until LT-ETEC colonization revealed that the hazard for the first colonization was time invariant. The hazard of diarrhea increased by 400-500% during the rainy season or among children 3 months of age or older who received avena, a barley drink. The best-fitting hazard models to durations until symptomatic expression of LT-ETEC infection all increased through time. This hazard was inversely impacted by the overall amount of LT-ETEC-specific, immunoglobulin A antibodies the infant received via the mother's breast milk and by the provision of traditional medicinal teas.
Long
K Z
KZ
Division of Population Dynamics and Epidemiology, Instituto Nacional de Salud Publica, Secretaria de Salud y Asistencia, Cuernavaca, Morelos, Mexico.
Wood
J W
JW
Vasquez Gariby
E
E
Weiss
K M
KM
Mathewson
J J
JJ
de la Cabada
F J
FJ
DuPont
H L
HL
Wilson
R A
RA
D001427:Bacterial Toxins / Q000032:analysis / Q000096:biosynthesis*; D001942:Breast Feeding; D015331:Cohort Studies; D003968:Diarrhea, Infantile / Q000453:epidemiology* / Q000382:microbiology; D004768:Enterotoxins / Q000032:analysis / Q000096:biosynthesis*; D004926:Escherichia coli / Q000378:metabolism; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D029968:Escherichia coli Proteins; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D008800:Mexico / Q000453:epidemiology; D008895:Milk, Human / Q000276:immunology / Q000382:microbiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012621:Seasons; D012959:Socioeconomic Factors; D014504:Urban Health
D001427:Bacterial Toxins; D004768:Enterotoxins; D029968:Escherichia coli Proteins; D007070:Immunoglobulin A; C027538:heat-labile enterotoxin, E coli