title: Contribution of enteric infection, altered intestinal barrier function, and maternal malnutrition to infant malnutrition in Bangladesh.
abstract: BACKGROUND
  Malnourished children are at increased risk for death due to diarrhea. Our goal was to determine the contribution of specific enteric infections to malnutrition-associated diarrhea and to determine the role of enteric infections in the development of malnutrition.
  
  
  METHODS
  Children from an urban slum in Bangladesh were followed for the first year of life by every-other-day home visits. Enteropathogens were identified in diarrheal and monthly surveillance stools; intestinal barrier function was measured by serum endocab antibodies; and nutritional status was measured by anthropometry.
  
  
  RESULTS
  Diarrhea occurred 4.69 ± 0.19 times per child per year, with the most common infections caused by enteric protozoa (amebiasis, cryptosporidiosis, and giardiasis), rotavirus, astrovirus, and enterotoxigenic Escherichia coli (ETEC). Malnutrition was present in 16.3% of children at birth and 42.4% at 12 months of age. Children malnourished at birth had increased Entamoeba histolytica, Cryptosporidium, and ETEC infections and more severe diarrhea. Children who became malnourished by 12 months of age were more likely to have prolonged diarrhea, intestinal barrier dysfunction, a mother without education, and low family expenditure.
  
  
  CONCLUSIONS
  Prospective observation of infants in an urban slum demonstrated that diarrheal diseases were associated with the development of malnutrition that was in turn linked to intestinal barrier disruption and that diarrhea was more severe in already malnourished children. The enteric protozoa were unexpectedly important causes of diarrhea in this setting. This study demonstrates the complex interrelationship of malnutrition and diarrhea in infants in low-income settings and points to the potential for infectious disease interventions in the prevention and treatment of malnutrition.
authors: International Centre for Diarrhoeal Disease Research, Laboratory Sciences Division, Dhaka, Bangladesh.
authors: Dinesh
authors: D
authors: Mondal
authors: Juliana
authors: J
authors: Minak
authors: Masud
authors: M
authors: Alam
authors: Yue
authors: Y
authors: Liu
authors: Jing
authors: J
authors: Dai
authors: Poonum
authors: P
authors: Korpe
authors: Lei
authors: L
authors: Liu
authors: Rashidul
authors: R
authors: Haque
authors: William A
authors: WA
authors: Petri
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D016009:Chi-Square Distribution; D003967:Diarrhea / Q000453:epidemiology* / Q000378:metabolism / Q000382:microbiology / Q000469:parasitology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000191:economics / Q000382:microbiology / Q000469:parasitology; D009017:Morbidity; D009752:Nutritional Status; D011204:Poverty Areas; D011446:Prospective Studies; D012959:Socioeconomic Factors