title: Association of vitamin D status with incidence of enterotoxigenic, enteropathogenic and enteroaggregative Escherichia coli diarrhoea in children of urban Bangladesh.
abstract: OBJECTIVE
  To evaluate the association between vitamin D status and diarrhoeal episodes by enterotoxigenic (ETEC), enteropathogenic (EPEC) and enteroaggregative (EAEC) E. coli in underweight and normal-weight children aged 6-24 months in urban Bangladesh.
  
  
  METHODS
  Cohorts of 446 normal-weight and 466 underweight children were tested separately for ETEC, EPEC and EAEC from diarrhoeal stool samples collected during 5 months of follow-up while considering vitamin D status at enrolment as the exposure. Cox proportional hazards models with unordered failure events of the same type were used to determine diarrhoeal risk factors after adjusting for sociodemographic and concurrent micronutrient status.
  
  
  RESULTS
  Vitamin D status was not independently associated with the risk of incidence of ETEC, EPEC and EAEC diarrhoea in underweight children, but moderate-to-severe retinol deficiency was associated with reduced risk for EPEC diarrhoea upon adjustment. Among normal-weight children, insufficient vitamin D status and moderate-to-severe retinol deficiency were independently associated with 44% and 38% reduced risk of incidence of EAEC diarrhoea, respectively. These children were at higher risk of ETEC diarrhoea with vitamin D deficiency status when adjusted for micronutrient status only.
  
  
  CONCLUSIONS
  This study demonstrates for the first time that normal-weight children with insufficient vitamin D status have a reduced risk of EAEC diarrhoea than children with sufficient status. Moderate-to-severe deficiency of serum retinol is associated with reduced risk of EPEC and EAEC diarrhoea in underweight and normal-weight children.
authors.affiliation: School of Public Health, The University of Queensland, Brisbane, Qld, Australia.|Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: A M S
authors.initials: AM
authors.lastname: Ahmed
authors.affiliation: School of Veterinary Science, The University of Queensland, Gatton, Qld, Australia.|Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: R J
authors.initials: RJ
authors.lastname: Soares Magalhaes
authors.affiliation: Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.|Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: K Z
authors.initials: KZ
authors.lastname: Long
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: T
authors.initials: T
authors.lastname: Ahmed
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Md A
authors.initials: MA
authors.lastname: Alam
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Md I
authors.initials: MI
authors.lastname: Hossain
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Md M
authors.initials: MM
authors.lastname: Islam
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: M
authors.initials: M
authors.lastname: Mahfuz
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: D
authors.initials: D
authors.lastname: Mondal
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: R
authors.initials: R
authors.lastname: Haque
authors.affiliation: School of Public Health, The University of Queensland, Brisbane, Qld, Australia.|Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: A A
authors.initials: AA
authors.lastname: Mamun
keywords: 
  Escherichia coli
  ; Bangladesh; Diarrea; Micronutrientes; Niños menores de 2; diarrhoea; diarrhée; enfants de moins de 2 ans; micronutrient; micronutriment; under 2 children