BACKGROUND & AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND & AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Margaret Kosek; Pablo Peñataro Yori; William K Pan; Maribel Paredes Olortegui; Robert H Gilman; Juan Perez; Cesar Banda Chavez; Graciela Meza Sanchez; Rosa Burga; Eric Hall Journal: Pediatrics Date: 2008-08-18 Impact factor: 7.124
Authors: Clayton Harro; David Sack; A Louis Bourgeois; R Walker; Barbara DeNearing; Andrea Feller; Subhra Chakraborty; Charlotte Buchwaldt; Michael J Darsley Journal: Clin Vaccine Immunol Date: 2011-10-12
Authors: Katharine A Schilling; Richard Omore; Gordana Derado; Tracy Ayers; John B Ochieng; Tamer H Farag; Dilruba Nasrin; Sandra Panchalingam; James P Nataro; Karen L Kotloff; Myron M Levine; Joseph Oundo; Michelle B Parsons; Cheryl Bopp; Kayla Laserson; Christine E Stauber; Richard Rothenberg; Robert F Breiman; Ciara E O'Reilly; Eric D Mintz Journal: Am J Trop Med Hyg Date: 2017-07 Impact factor: 2.345
Authors: Patricia B Pavlinac; Grace C John-Stewart; Jaqueline M Naulikha; Frankline M Onchiri; Donna M Denno; Elizabeth A Odundo; Benson O Singa; Barbra A Richardson; Judd L Walson Journal: AIDS Date: 2014-09-24 Impact factor: 4.177
Authors: BreOnna C DeLaine; Tao Wu; Christen L Grassel; Avital Shimanovich; Marcela F Pasetti; Myron M Levine; Eileen M Barry Journal: Pathog Dis Date: 2016-04-21 Impact factor: 3.166
Authors: Michael J Darsley; Subhra Chakraborty; Barbara DeNearing; David A Sack; Andrea Feller; Charlotte Buchwaldt; A Louis Bourgeois; Richard Walker; Clayton D Harro Journal: Clin Vaccine Immunol Date: 2012-10-03