title: Fecal Markers of Environmental Enteropathy and Subsequent Growth in Bangladeshi Children.
abstract: Environmental enteropathy (EE), a subclinical intestinal disorder characterized by mucosal inflammation, reduced barrier integrity, and malabsorption, appears to be associated with increased risk of stunting in children in low- and middle-income countries. Fecal biomarkers indicative of EE (neopterin [NEO], myeloperoxidase [MPO], and alpha-1-antitrypsin [AAT]) have been negatively associated with 6-month linear growth. Associations between fecal markers (NEO, MPO, and AAT) and short-term linear growth were examined in a birth cohort of 246 children in Bangladesh. Marker concentrations were categorized in stool samples based on their distribution (< first quartile, interquartile range, > third quartile), and a 10-point composite EE score was calculated. Piecewise linear mixed-effects models were used to examine the association between markers measured quarterly (in months 3-21, 3-9, and 12-21) and 3-month change in length-for-age z-score (ΔLAZ). Children with high MPO levels at quarterly time points lost significantly more LAZ per 3-month period during the second year of life than those with low MPO (ΔLAZ = -0.100; 95% confidence interval = -0.167 to -0.032). AAT and NEO were not associated with growth; however, composite EE score was negatively associated with subsequent 3-month growth. In this cohort of children from an urban setting in Bangladesh, elevated MPO levels, but not NEO or AAT levels, were associated with decreases in short-term linear growth during the second year of life, supporting previous data suggesting the relevance of MPO as a marker of EE.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington. marndt@uw.edu.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Arndt
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington. Department of Global Health, University of Washington, Seattle, Washington.
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Mahfuz
authors.affiliation: Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington. Department of Global Health, University of Washington, Seattle, Washington. Department of Medicine, University of Washington, Seattle, Washington. Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington. Department of Pediatrics, University of Washington, Seattle, Washington. Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Denno
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia.
authors.forename: William A
authors.initials: WA
authors.lastname: Petri
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Asociación Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
authors.forename: Judd L
authors.initials: JL
authors.lastname: Walson
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D015415:Biomarkers / Q000032:analysis; D002675:Child, Preschool; D003968:Diarrhea, Infantile / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D005243:Feces / Q000737:chemistry*; D005260:Female; D006130:Growth Disorders / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D019798:Neopterin / Q000032:analysis; D009195:Peroxidase / Q000032:analysis; D011446:Prospective Studies; D000515:alpha 1-Antitrypsin / Q000032:analysis
chemical_list: D015415:Biomarkers; C043392:SERPINA1 protein, human; D000515:alpha 1-Antitrypsin; D019798:Neopterin; D009195:Peroxidase