Determinant Variables, Enteric Pathogen Burden, Gut Function and Immune-related Inflammatory Biomarkers Associated With Childhood Malnutrition

Abstract

Malnutrition results in serious consequences for growth and cognitive development in children. We studied select child and maternal biological factors, socio-economic factors, enteric pathogenic burden, and gut function biomarkers in 402 children 6–24 months of age in North-eastern 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 electrical 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 two 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 (SAA-1) and soluble cluster of differentiation protein 14 (sCD14) biomarkers (P < 0.001). SAA-1 and sCD14 were also associated with better nutritional z-scores. Neonatal, maternal, and socio-economic factors were associated with malnutrition in children. There was a substantial subclinical enteric pathogen burden, particularly with EAEC, in malnourished children.

Changing demographics of visceral leishmaniasis in northeast Brazil: Lessons for the future

“…There is an increase in vaccine coverage, with more uniform administration of vaccines as polio, measles, BCG and others. Those measures have been associated with increased average birth weight [ 22 ; 44 ], decreased childhood diarrheal diseases [ 45 ; 46 ]. The improved health could lead to healthier gut brush border, better absorption of nutrients and protection against opportunistic pathogens such as Leishmania .…”

Virulence-Related Genes and Coenteropathogens Associated with Clinical Outcomes of Enteropathogenic Escherichia coli Infections in Children from the Brazilian Semiarid Region: a Case-Control Study of Diarrhea

“…Indeed, this is the first study to show the burdens of EPEC on undernutrition. Other studies have tried to associate enteropathogens, including diarrheagenic E. coli, such as enteroaggregative E. coli (EAEC), with undernutrition in child populations (42,43). Recent data emerging from MAL-ED studies have reinforced the importance of even asymptomatic enteric infections as a cause of growth impairment in children from developing countries (44,45), which was observed due to the use of molecular diagnostic techniques instead of conventional techniques (46,47).…”

Nutritional status, diet and viral respiratory infections: perspectives for severe acute respiratory syndrome coronavirus 2

“…These alterations increase nutritional demands and, added to appetite loss, induce or aggravate malnutrition (41,43) . Malnutrition, in turn, increases the risk of infection by reducing gut barrier function (41,44) , modifying the intestinal microbiota (45) , compromising immune cell generation and activation, altering the regulation of inflammatory adipocytokines and limiting the uptake of macro-and key micronutrients (46,47) . Undernutrition also decreases the lipid tissue, altering adipokine production, ultimately leading to innate and adaptive immunity restrictions.…”