Effects of Shigella-, Campylobacter- and ETEC-associated diarrhea on childhood growth

Pediatr Infect Dis J. 2014 Oct;33(10):1004-9. doi: 10.1097/INF.0000000000000351.


Background: Studies examining the etiology-specific effects of diarrheal disease on growth are limited and variable in their analytic methods, making comparisons difficult and priority setting based on these findings challenging. A study by Black et al (Black RE, Brown KH, Becker S. Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh. Pediatrics. 1984;33:1004-1009.) examined the association between Shigella and enterotoxigenic Escherichia coli-related disease and weight gain and linear growth in Bangladeshi children aged 0-5 years. We estimated similar associations in a 2002 cohort of 0- to 6-year-old children in the Peruvian Amazon.

Methods: Diarrheal surveillence was conducted using household visits 3 times per week. Anthropometry was collected monthly. Mixed-effect models were used to estimate the association between Shigella, ETEC and Campylobacter diarrhea and weight gain in a 2-month period and linear growth over a 9-month period. Diarrheal disease burdens and growth intervals were quantified so as to be as comparable as possible to the original report.

Results: Shigella- and ETEC-associated diarrhea were not associated with diminished weight gain, although the association between ETEC diarrhea and weight gain (-4.5 g/percent of days spent with ETEC, P = 0.098) was twice that of other etiologic agents, as well as similar in magnitude to the original report. Shigella-associated diarrhea was associated with decreased linear growth (0.055 cm less growth/percent days, P = 0.008), also similar to the original study.

Conclusions: Our findings suggest that associations between enteropathogen-specific diarrheal episodes and growth, particularly Shigella, are comparable across geographic and epidemiological contexts.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Campylobacter / isolation & purification
  • Campylobacter Infections / epidemiology
  • Campylobacter Infections / pathology*
  • Child
  • Child Development*
  • Child, Preschool
  • Diarrhea / epidemiology
  • Diarrhea / pathology*
  • Dysentery, Bacillary / epidemiology
  • Dysentery, Bacillary / pathology*
  • Enterotoxigenic Escherichia coli / isolation & purification
  • Epidemiologic Studies
  • Escherichia coli Infections / epidemiology
  • Escherichia coli Infections / pathology*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Peru / epidemiology
  • Prospective Studies
  • Shigella / isolation & purification