Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 139; no. 4; p. 1156
• Main Authors: Moore, Sean R, Lima, Noélia L, Soares, Alberto M, Oriá, Reinaldo B, Pinkerton, Relana C, Barrett, Leah J, Guerrant, Richard L, Lima, Aldo A M
• Format: Journal Article
• Language: English
• Published: United States 01.10.2010
• Subjects: Acute Disease; Ascariasis - complications; Breast Feeding; Child; Child, Preschool; Cohort Studies; Diarrhea - etiology; Female; Growth Disorders - etiology; Humans; Infant; Male; Malnutrition - etiology; Proportional Hazards Models; Risk; Risk Factors
• ISSN: 1528-0012
• DOI: 10.1053/j.gastro.2010.05.076

Prolonged episodes of acute diarrhea (ProD; duration 7-13 days) or persistent diarrhea (PD; duration ≥14 days) are important causes of undernutrition, yet the epidemiology and nutritional impact of ProD are poorly understood. We conducted a 10-year cohort study of 414 children from a Brazilian shantytown who were followed from birth; data were collected on diarrhea, enteric pathogens, and anthropometry. During 1276 child-years of observation, we recorded 3257 diarrheal episodes. ProD was twice as common as PD (12% and 5% of episodes, respectively); ProD and PD together accounted for 50% of all days with diarrhea. ProD was more common in infants whose mothers had not completed primary school (relative risk [RR], 2.1; 95% confidence interval: 1.02-2.78). Early weaning was associated with earlier onset of ProD (Spearman ρ = 0.309; P = .005). Infants with ProD were twice as likely to develop PD in later childhood (log rank, P = .002) compared with infants with only acute diarrhea (AD; duration <7 days), even after controlling for confounders. Children's growth was more severely stunted before their first episode of ProD, compared with AD (mean height-for-age Z score (HAZ) -0.81 vs -0.51, respectively, P < .05, unpaired t test). Following ProD, HAZ (ΔHAZ = -0.232) and weight-for-age (ΔWAZ = -0.26) significantly decreased (P < .005 in paired t tests). ProD was associated with Cryptosporidium and Shigella infections. ProD accounts for significant morbidity and identifies children at risk of a vicious cycle of diarrhea and malnutrition. Further studies are needed to address the recognition and control of ProD and its consequences in resource-limited settings and assess its role in PD pathogenesis.