title: Does childhood diarrhea influence cognition beyond the diarrhea-stunting pathway?
abstract: BACKGROUND
  Diarrhea is a leading cause of morbidity among children under 5 years of age in low- and middle-income countries yet the additional effects and sequelae, such as cognitive impairment associated with diarrhea, have not been quantified.
  
  
  METHODS
  We quantified the association between diarrhea prevalence and cognitive outcomes while controlling for linear growth in 4 study populations. Cognition was assessed using different methods across sites and was expressed in standardized units. We built linear regression models for each study with standardized cognitive score as the outcome and diarrhea prevalence as the main predictor variable. We then conducted meta-analyses of the regression coefficients to generate pooled estimates of the association between diarrhea prevalence and cognition whilst controlling for anthropometric status and other covariates.
  
  
  RESULTS
  Diarrhea was not a significant predictor of cognitive score in any site in the regression models or in the meta-analyses (Coefficient = 0.07; 95% CI: -0.1, 0.2). The length for age Z- score was negatively related to cognition in all sites (0.18; 95% CI: 0.14, 0.21), with coefficients remarkably similar across sites (Coefficient Range: 0.168-0.186).
  
  
  CONCLUSIONS
  We did not demonstrate an association between diarrhea and cognition with stunting included in the model. The links between diarrhea, stunting, and cognition provide additional rationale for accelerating interventions to reduce diarrhea.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. cfischer@jhsph.edu
authors.forename: Christa L
authors.initials: CL
authors.lastname: Fischer Walker
authors.forename: Laura
authors.initials: L
authors.lastname: Lamberti
authors.forename: Linda
authors.initials: L
authors.lastname: Adair
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
authors.forename: Andres G
authors.initials: AG
authors.lastname: Lescano
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Martorell
authors.forename: Relana C
authors.initials: RC
authors.lastname: Pinkerton
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D003967:Diarrhea / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male