Identification of Etiology-Specific Diarrhea Associated With Linear Growth Faltering in Bangladeshi Infants

Childhood diarrhea in low-resource settings has been variably linked to linear growth shortfalls. However, the association between etiology-specific diarrhea and growth has not been comprehensively evaluated. We tested diarrheal stools collected from the Performance of Rotavirus and Oral Polio Vaccines in Developing Countries study from 2011 to 2013 in Dhaka, Bangladesh, by quantitative polymerase chain reaction for a broad range of enteropathogens to characterize diarrhea etiology and examine the association between etiology-specific diarrhea and linear growth and systemic inflammation. Pathogen-specific burdens of diarrhea were determined using attributable fractions. Linear regression was used to examine associations of pathogen-specific diarrhea with length-for-age z scores (LAZ) and serum C-reactive protein. There was no relationship between all-cause diarrhea and length at 12 months (change in 12-month LAZ per episode, -0.01, 95% confidence interval (CI): -0.06, 0.03). However, Cryptosporidium (change in 12-month LAZ per attributable episode, -0.23, 95% CI: -0.50, 0.03), Campylobacter jejuni/coli (change of -0.16, 95% CI: -0.32, -0.01), and Shigella/enteroinvasive Escherichia coli diarrhea (change of -0.12, 95% CI: -0.26, 0.03) were associated with linear growth deficits. Diarrhea attributable to C. jejuni/coli and Shigella/enteroinvasive E. coli were associated with elevated C-reactive protein. The association between diarrhea and linear growth appears to be pathogen-specific, reinforcing the need for pathogen-specific interventions.