Cargando…

Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study

BACKGROUND: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD. ME...

Descripción completa

Detalles Bibliográficos
Autores principales: Brander, Rebecca L., Pavlinac, Patricia B., Walson, Judd L., John-Stewart, Grace C., Weaver, Marcia R., Faruque, Abu S. G., Zaidi, Anita K. M., Sur, Dipika, Sow, Samba O., Hossain, M. Jahangir, Alonso, Pedro L., Breiman, Robert F., Nasrin, Dilruba, Nataro, James P., Levine, Myron M., Kotloff, Karen L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878715/
https://www.ncbi.nlm.nih.gov/pubmed/31767012
http://dx.doi.org/10.1186/s12916-019-1441-3
_version_ 1783473505597128704
author Brander, Rebecca L.
Pavlinac, Patricia B.
Walson, Judd L.
John-Stewart, Grace C.
Weaver, Marcia R.
Faruque, Abu S. G.
Zaidi, Anita K. M.
Sur, Dipika
Sow, Samba O.
Hossain, M. Jahangir
Alonso, Pedro L.
Breiman, Robert F.
Nasrin, Dilruba
Nataro, James P.
Levine, Myron M.
Kotloff, Karen L.
author_facet Brander, Rebecca L.
Pavlinac, Patricia B.
Walson, Judd L.
John-Stewart, Grace C.
Weaver, Marcia R.
Faruque, Abu S. G.
Zaidi, Anita K. M.
Sur, Dipika
Sow, Samba O.
Hossain, M. Jahangir
Alonso, Pedro L.
Breiman, Robert F.
Nasrin, Dilruba
Nataro, James P.
Levine, Myron M.
Kotloff, Karen L.
author_sort Brander, Rebecca L.
collection PubMed
description BACKGROUND: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD. METHODS: Using data from the Global Enteric Multicenter Study of children 0–23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model. RESULTS: Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50–90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was − 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12–23 months old, those 0–6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6–12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%). CONCLUSION: Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions.
format Online
Article
Text
id pubmed-6878715
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-68787152019-11-29 Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study Brander, Rebecca L. Pavlinac, Patricia B. Walson, Judd L. John-Stewart, Grace C. Weaver, Marcia R. Faruque, Abu S. G. Zaidi, Anita K. M. Sur, Dipika Sow, Samba O. Hossain, M. Jahangir Alonso, Pedro L. Breiman, Robert F. Nasrin, Dilruba Nataro, James P. Levine, Myron M. Kotloff, Karen L. BMC Med Research Article BACKGROUND: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD. METHODS: Using data from the Global Enteric Multicenter Study of children 0–23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model. RESULTS: Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50–90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was − 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12–23 months old, those 0–6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6–12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%). CONCLUSION: Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions. BioMed Central 2019-11-25 /pmc/articles/PMC6878715/ /pubmed/31767012 http://dx.doi.org/10.1186/s12916-019-1441-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Brander, Rebecca L.
Pavlinac, Patricia B.
Walson, Judd L.
John-Stewart, Grace C.
Weaver, Marcia R.
Faruque, Abu S. G.
Zaidi, Anita K. M.
Sur, Dipika
Sow, Samba O.
Hossain, M. Jahangir
Alonso, Pedro L.
Breiman, Robert F.
Nasrin, Dilruba
Nataro, James P.
Levine, Myron M.
Kotloff, Karen L.
Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study
title Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study
title_full Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study
title_fullStr Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study
title_full_unstemmed Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study
title_short Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study
title_sort determinants of linear growth faltering among children with moderate-to-severe diarrhea in the global enteric multicenter study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878715/
https://www.ncbi.nlm.nih.gov/pubmed/31767012
http://dx.doi.org/10.1186/s12916-019-1441-3
work_keys_str_mv AT branderrebeccal determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT pavlinacpatriciab determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT walsonjuddl determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT johnstewartgracec determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT weavermarciar determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT faruqueabusg determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT zaidianitakm determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT surdipika determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT sowsambao determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT hossainmjahangir determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT alonsopedrol determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT breimanrobertf determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT nasrindilruba determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT natarojamesp determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT levinemyronm determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy
AT kotloffkarenl determinantsoflineargrowthfalteringamongchildrenwithmoderatetoseverediarrheaintheglobalentericmulticenterstudy