Impact of enteropathogens on faltering growth in a resource-limited setting

Furqan Kabir; Junaid Iqbal; Zehra Jamil; Najeeha Talat Iqbal; Indika Mallawaarachchi; Fatima Aziz; Adil Kalam; Sahrish Muneer; Aneeta Hotwani; Sheraz Ahmed; Fayaz Umrani; Sana Syed; Kamran Sadiq; Jennie Z Ma; Sean R Moore; Asad Ali

doi:10.3389/fnut.2022.1081833

Impact of enteropathogens on faltering growth in a resource-limited setting

Front Nutr. 2023 Jan 10:9:1081833. doi: 10.3389/fnut.2022.1081833. eCollection 2022.

Authors

Furqan Kabir¹, Junaid Iqbal^{1

2}, Zehra Jamil^{1

2}, Najeeha Talat Iqbal^{1

2}, Indika Mallawaarachchi³, Fatima Aziz¹, Adil Kalam¹, Sahrish Muneer¹, Aneeta Hotwani¹, Sheraz Ahmed¹, Fayaz Umrani¹, Sana Syed^{1

4}, Kamran Sadiq¹, Jennie Z Ma³, Sean R Moore⁴, Asad Ali¹

Affiliations

¹ Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
² Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan.
³ Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
⁴ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States.

Abstract

Introduction: Environmental enteropathy is an important contributor to childhood malnutrition in the developing world. Chronic exposure to fecal pathogens leads to alteration in intestinal structure and function, resulting in impaired gut immune function, malabsorption, and growth faltering leading to environmental enteropathy.

Methods: A community-based intervention study was carried out on children till 24 months of age in Matiari district, Pakistan. Blood and fecal specimens were collected from the enrolled children aged 3-6 and 9 months. A real-time PCR-based TaqMan array card (TAC) was used to detect enteropathogens.

Results: Giardia, Campylobacter spp., enteroaggregative Escherichia coli (EAEC), Enteropathogenic Escherichia coli (EPEC), Enterotoxigenic Escherichia coli (ETEC), and Cryptosporidium spp. were the most prevailing enteropathogens in terms of overall positivity at both time points. Detection of protozoa at enrollment and 9 months was negatively correlated with rate of change in height-for-age Z (ΔHAZ) scores during the first and second years of life. A positive association was found between Giardia, fecal lipocalin (LCN), and alpha 1-Acid Glycoprotein (AGP), while Campylobacter spp. showed positive associations with neopterin (NEO) and myeloperoxidase (MPO).

Conclusion: Protozoal colonization is associated with a decline in linear growth velocity during the first 2 years of life in children living in Environmental enteric dysfunction (EED) endemic settings. Mechanistic studies exploring the role of cumulative microbial colonization, their adaptations to undernutrition, and their influence on gut homeostasis are required to understand symptomatic enteropathogen-induced growth faltering.

Keywords: Giardia; TaqMan array card (TAC); biomarkers; enteropathogen; environmental enteric dysfunction (EED); growth faltering.

Grants and funding

K23 DK117061/DK/NIDDK NIH HHS/United States