Project Details

High-frequency measures of early life enteric pathogen burden and the influence on child growth and nutrition

Caitlin Hemlock, PhD, MS

Summary

BACKGROUND: Nearly 150 million children less than 5 years old fail to reach their full growth potential worldwide, with a higher prevalence of stunting in low-resource settings, where poverty, malnutrition, and infectious diseases are common. Enteric infections during the critical window for growth (first 1000 days), particularly after six months when growth faltering increases, can set children on a trajectory that impairs long-term growth and nutritional status.  GAP: Most analyses of child growth have used less frequent measures of pathogen burden (monthly at most). Evaluating longitudinal patterns with high-frequency sampling offers the potential to advance understanding of the relationship between pathogen infection and child outcomes. Previous studies have also only considered single pathogen burden, and evidence is becoming increasingly clear on the importance of coinfections and multi-pathogen burden for adverse outcomes. HYPOTHESIS: Pathogen burden in children 6-12 months will be negatively associated with a) growth between 6-12 months and b) biomarkers associated with growth at 12 and 24 months. METHODS: I will analyze children in the ECoMiD birth cohort high-frequency pathogen burden data between 6-12 months of age. We have biweekly stool samples on 60 children (770 total samples) and multiplex PCR testing for 22 enteropathogens. I will calculate pathogen specific incidence rates for both aims and use multivariable models to assess associations between pathogen burden and growth and biomarker outcomes. I will use anthropometry data converted to 3-month length velocity Z-scores using WHO 2006 standards and analyze blood samples collected at 12 and 24 months for biomarkers indicative of key micronutrients and systemic and gut inflammation.  RESULTS: Pending. IMPACT: Our high-resolution data can identify pathogen-specific burdens most strongly associated with poor nutritional outcomes. Our results will help guide priorities for future vaccine targets and other intervention approaches for the many children in low-resource settings who are exposed to multiple pathogens from a very young age.