Protection against diarrhea associated with Giardia intestinalis is lost with Multi-Nutrient Supplementation: A Study in Tanzanian Children

Autor: Huub F. J. Savelkoul, Jacobien Veenemans, Maarten J. Ottenhof, Erasto V. Mbugi, Theo G. Mank, Amrish Baidjoe, Jos P. M. Wielders, Ayşe Y Demir, Hans Verhoef
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Giardiasis
Male
Epidemiology
consequences
medicine.disease_cause
Tanzania
law.invention
Cohort Studies
Placebos
Feces
Randomized controlled trial
law
Prospective Studies
education.field_of_study
Virulence
biology
lcsh:Public aspects of medicine
Giardia
Diarrhea
Treatment Outcome
Infectious Diseases
young-children
Child
Preschool
Carrier State
bangladesh
Medicine
lamblia infection
Female
Public Health
medicine.symptom
Research Article
Cohort study
protozoal parasites
lcsh:Arctic medicine. Tropical medicine
Fever
Diet therapy
lcsh:RC955-962
Population
Context (language use)
Celbiologie en Immunologie
Environmental health
medicine
Humans
Giardia lamblia
israeli bedouin infants
education
Nutrition
childhood
disease
business.industry
Public Health
Environmental and Occupational Health
Infant
natural-history
lcsh:RA1-1270
biology.organism_classification
Cell Biology and Immunology
Food
helicobacter-pylori
Immunology
WIAS
business
Diet Therapy
Zdroj: PLoS Neglected Tropical Diseases, 5(6)
PLoS Neglected Tropical Diseases, Vol 5, Iss 6, p e1158 (2011)
PLoS Neglected Tropical Diseases 5 (2011) 6
PLoS Neglected Tropical Diseases
ISSN: 1935-2727
Popis: Background Asymptomatic carriage of Giardia intestinalis is highly prevalent among children in developing countries, and evidence regarding its role as a diarrhea-causing agent in these settings is controversial. Impaired linear growth and cognition have been associated with giardiasis, presumably mediated by malabsorption of nutrients. In a prospective cohort study, we aim to compare diarrhea rates in pre-school children with and without Giardia infection. Because the study was conducted in the context of an intervention trial assessing the effects of multi-nutrients on morbidity, we also assessed how supplementation influenced the relationship between Giardia and diarrhoea rates, and to what extent Giardia modifies the intervention effect on nutritional status. Methods and Findings Data were collected in the context of a randomized placebo-controlled efficacy trial with 2×2 factorial design assessing the effects of zinc and/or multi-micronutrients on morbidity (n = 612; height-for-age z-score
Author Summary Giardia intestinalis is a well-known cause of diarrhea in industrialized countries. In children in developing countries, asymptomatic infections are common and their role as cause of diarrhea has been questioned. In a cohort of rural Tanzanian pre-school children, we assessed the association between the presence of Giardia at baseline and subsequent diarrhea risk. The study was conducted in the context of a randomised trial assessing the effect of supplementation with zinc and other micro-nutrients on malaria, and half of the children daily received a multi-nutrient supplement. Surprisingly, we found that the presence of Giardia at baseline was associated with a substantial reduction in diarrhea risk. Multivariate statistical analysis showed that this protection could not be explained by differences in age or walking distance to the dispensary between children with and without Giardia. Because we cannot exclude that children differed in other (unmeasured) characteristics, we cannot draw firm conclusions about the causality of the observed association, but our findings support the view that the parasite is not an important cause of diarrhea in highly endemic settings. Striking was that the Giardia-associated protection was lost when children received multi-nutrients. Our data do not provide information about the mechanisms involved, but suggest that multi-nutrients may influence the compositionor pathogenicity of intestinal biota.
Databáze: OpenAIRE
Externí odkaz: