title: First detected Helicobacter pylori infection in infancy modifies the association between diarrheal disease and childhood growth in Peru.
abstract: BACKGROUND
  In endemic settings, Helicobacter pylori infection can occur shortly after birth and may be associated with a reduction in childhood growth.
  
  
  METHODS
  This study investigated what factors promote earlier age of first H. pylori infection and evaluated the role of H. pylori infection in infancy (6-11 months) versus early childhood (12-23 months) on height. We included 183 children near birth from a peri-urban shanty town outside of Lima, Peru. Field-workers collected data on socioeconomic status (SES), daily diarrheal and breast-feeding history, antibiotic use, anthropometrics, and H. pylori status via carbon 13-labeled urea breath test up to 24 months after birth. We used a proportional hazards model to assess risk factors for earlier age at first detected infection and linear mixed-effects models to evaluate the association of first detected H. pylori infection during infancy on attained height.
  
  
  RESULTS
  One hundred and forty (77%) were infected before 12 months of age. Lower SES was associated with earlier age at first detected H. pylori infection (low vs middle-to-high SES Hazard ratio (HR) 1.59, 95% CI 1.16, 2.19; p = .004), and greater exclusive breast-feeding was associated with reduced likelihood (HR 0.63, 95% CI 0.40, 0.98, p = .04). H. pylori infection in infancy was not independently associated with growth deficits (p = .58). However, children who had their first detected H. pylori infection in infancy (6-11 months) versus early childhood (12-23 months) and who had an average number of diarrhea episodes per year (3.4) were significantly shorter at 24 months (-0.37 cm, 95% CI, -0.60, -0.15 cm; p = .001).
  
  
  CONCLUSIONS
  Lower SES was associated with a higher risk of first detected H. pylori infection during infancy, which in turn augmented the adverse association of diarrheal disease on linear growth.
authors.affiliation: Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Devan
authors.initials: D
authors.lastname: Jaganath
authors.forename: Mayuko
authors.initials: M
authors.lastname: Saito
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Dulciene M M
authors.initials: DM
authors.lastname: Queiroz
authors.forename: Gifone A
authors.initials: GA
authors.lastname: Rocha
authors.forename: Vitaliano
authors.initials: V
authors.lastname: Cama
authors.forename: Lilia
authors.initials: L
authors.lastname: Cabrera
authors.forename: Dermot
authors.initials: D
authors.lastname: Kelleher
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Windle
authors.forename: Jean E
authors.initials: JE
authors.lastname: Crabtree
authors.forename: William
authors.initials: W
authors.lastname: Checkley
mesh_terms: D000818:Animals; D001944:Breath Tests; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D003967:Diarrhea / Q000150:complications* / Q000453:epidemiology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010568:Peru / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D012923:Social Class; D013383:Suburban Population; D014508:Urea / Q000032:analysis
chemical_list: D014508:Urea
keywords: Child; Helicobacter pylori; diarrhea; growth