title: Determinant Variables, Enteric Pathogen Burden, Gut Function and Immune-related Inflammatory Biomarkers Associated With Childhood Malnutrition: A Prospective Case-Control Study in Northeastern Brazil.
abstract: Malnutrition results in serious consequences for growth and cognitive development in children. We studied select child and maternal biologic factors, socioeconomic factors, enteric pathogenic burden and gut function biomarkers in 402 children 6-24 months of age in Northeastern Brazil. In this prospective case-control study, not being fed colostrum [odds ratio (OR): 3.29, 95% confidence interval (CI): 1.73-6.26], maternal age ≥18 years (OR: 1.88, 95% CI: 1.10-3.22) and no electric fan (OR: 2.46, 95% CI: 1.22-4.96) or bicycle (OR: 1.80, 95% CI: 1.10-2.95) in the household were positively associated, and higher birth weight (OR: 0.27, 95% CI: 0.19-0.38), larger head circumference (OR: 0.74, 95% CI: 0.66-0.82) and shortness of breath in the last 2 weeks (OR: 0.49, 95% CI: 0.27-0.90) were negatively associated with malnutrition. Subclinical enteric pathogen infections were common, and enteroaggregative Escherichia coli infections were more prevalent in malnourished children (P = 0.045). Biomarkers such as the lactulose-mannitol test, myeloperoxidase, neopterin and calprotectin were highly elevated in both malnourished and nourished children. Nourished children had a better systemic immune response than the malnourished children, as detected by elevated serum amyloid A-1 and soluble cluster of differentiation protein 14 biomarkers (P < 0.001). Serum amyloid A-1 and soluble cluster of differentiation protein 14 were also associated with better nutritional Z scores. Neonatal, maternal and socioeconomic factors were associated with malnutrition in children. There was a substantial subclinical enteric pathogen burden, particularly with enteroaggregative E. coli, in malnourished children.
authors.affiliation: From the *Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, †Department of Pediatric, Institute for the Promotion of Nutrition and Human Development, and ‡Department of Statistics and Applied Mathematics, Federal University of Ceará, Fortaleza, Ceará, Brazil; §Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio; and ¶Department of Medicine, Center for Global Health and Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia.
authors.forename: Aldo A M
authors.initials: AAM
authors.lastname: Lima
authors.forename: Álvaro M
authors.initials: ÁM
authors.lastname: Leite
authors.forename: Alessandra
authors.initials: A
authors.lastname: Di Moura
authors.forename: Noélia L
authors.initials: NL
authors.lastname: Lima
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Soares
authors.forename: Cláudia B
authors.initials: CB
authors.lastname: Abreu
authors.forename: José Quirino
authors.initials: JQ
authors.lastname: Filho
authors.forename: Rosa M S
authors.initials: RMS
authors.lastname: Mota
authors.forename: Ila F N
authors.initials: IFN
authors.lastname: Lima
authors.forename: Alexandre
authors.initials: A
authors.lastname: Havt
authors.forename: Pedro H Q S
authors.initials: PHQS
authors.lastname: Medeiros
authors.forename: Mara M G
authors.initials: MMG
authors.lastname: Prata
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Guedes
authors.forename: Paloma A
authors.initials: PA
authors.lastname: Cavalcante
authors.forename: Herlice N
authors.initials: HN
authors.lastname: Veras
authors.forename: Ana K S
authors.initials: AKS
authors.lastname: Santos
authors.forename: Sean R
authors.initials: SR
authors.lastname: Moore
authors.forename: Relana C
authors.initials: RC
authors.lastname: Pinkerton
authors.forename: Eric R
authors.initials: ER
authors.lastname: Houpt
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D015362:Child Nutrition Disorders / Q000453:epidemiology* / Q000378:metabolism / Q000382:microbiology / Q000503:physiopathology*; D002675:Child, Preschool; D054308:Enteropathogenic Escherichia coli; D004927:Escherichia coli Infections; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D006801:Humans; D007223:Infant; D007249:Inflammation; D044342:Malnutrition / Q000453:epidemiology* / Q000378:metabolism / Q000382:microbiology / Q000503:physiopathology*; D011446:Prospective Studies; D000685:Serum Amyloid A Protein / Q000032:analysis
chemical_list: D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; C521404:SAA1 protein, human; D000685:Serum Amyloid A Protein