Does childhood diarrhea influence cognition beyond the diarrhea-stunting pathway?

• Published in: PloS one Vol. 7; no. 10; p. e47908
• Main Authors: Fischer Walker, Christa L, Lamberti, Laura, Adair, Linda, Guerrant, Richard L, Lescano, Andres G, Martorell, Reynaldo, Pinkerton, Relana C, Black, Robert E
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.10.2012; Public Library of Science (PLoS)
• Subjects: Age; Analysis; Anthropometry; Biology; Body measurements; Caregivers; Child; Child & adolescent psychiatry; Child development; Child, Preschool; Children; Children & youth; Cognition; Cognition & reasoning; Cognition Disorders - complications; Cognition Disorders - epidemiology; Cognition Disorders - etiology; Cognitive ability; Cognitive development; Complications; Construction standards; Datasets; Diarrhea; Diarrhea - complications; Diarrhea - epidemiology; Diarrhea - physiopathology; Epidemiology; Family income; Female; Health surveillance; Households; Humans; Infections; Infectious diseases; Linear Models; Male; Malnutrition; Medicine; Meta-analysis; Morbidity; Mortality; Nutrition; Population studies; Public health; Regression analysis; Regression coefficients; Regression models; Socioeconomic factors; Studies; Surveillance; Variables; United States > US; Peru; Maryland; Virginia; Baltimore Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0047908

Diarrhea is a leading cause of morbidity among children under 5 years of age in low- and middle-income countries yet the additional effects and sequelae, such as cognitive impairment associated with diarrhea, have not been quantified. We quantified the association between diarrhea prevalence and cognitive outcomes while controlling for linear growth in 4 study populations. Cognition was assessed using different methods across sites and was expressed in standardized units. We built linear regression models for each study with standardized cognitive score as the outcome and diarrhea prevalence as the main predictor variable. We then conducted meta-analyses of the regression coefficients to generate pooled estimates of the association between diarrhea prevalence and cognition whilst controlling for anthropometric status and other covariates. Diarrhea was not a significant predictor of cognitive score in any site in the regression models or in the meta-analyses (Coefficient = 0.07; 95% CI: -0.1, 0.2). The length for age Z- score was negatively related to cognition in all sites (0.18; 95% CI: 0.14, 0.21), with coefficients remarkably similar across sites (Coefficient Range: 0.168-0.186). We did not demonstrate an association between diarrhea and cognition with stunting included in the model. The links between diarrhea, stunting, and cognition provide additional rationale for accelerating interventions to reduce diarrhea.