Effects of Cryptosporidium parvum infection in Peruvian children: Growth faltering and subsequent catch-up growth

William Checkley, Leonardo David Epstein, Robert H. Gilman, Robert E. Black, Lilia Cabrera, Charles R. Sterling

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Abstract

The authors conducted a 2-year (1989-1991) community-based longitudinal study in a shantytown in Lima, Peru, to examine the effect of Cryptosporidium parvum infection on child growth during the year following the onset of infection. A cohort of children, aged 0-3 months at recruitment, was followed monthly for anthropometrics, weekly for stool samples, and daily for diarrheal status. Data from 185 children in the cohort permitted a comparison of growth in C. parvum-infected and noninfected children. The analyses fitted smooth, flexible curves with a linear random-effects model to estimate growth differences between C. parvum-infected and noninfected children. Children infected with C. parvum experienced growth faltering, both in weight and in height, for several months after the onset of infection, followed by a period of catch-up growth. Younger children took longer to catch up in weight than did older children. Catch-up growth, however, did not occur in children infected between ages 0 and 5 months. These children did not catch up in height, and one year after infection they exhibited an average deficit of 0.95 cm (95% confidence interval (CI) 0.38-1.53) relative to noninfected children of similar age. Stunted children who became infected also did not catch up in either weight or height, and one year after infection they exhibited a height deficit of 1.05 cm (95% CI 0,46-1;66) relative to noninfected, stunted children of similar age. These results indicate that Cryptosporidium parvum has a lasting adverse effect on linear (height) growth, especially when acquired during infancy and when children are stunted before they become infected.

Original languageEnglish
Pages (from-to)497-506
Number of pages10
JournalAmerican Journal of Epidemiology
Volume148
Issue number5
DOIs
StatePublished - 1 Sep 1998
Externally publishedYes

Bibliographical note

Funding Information:
This study was funded in part by the NTH grant no. 3-UO1-A135894-O1 awarded to The Johns Hopkins University, and by the charitable RG-ER fund for the advancement of research in tropical medicine. Preliminary results of this study were presented at the Fifth Annual Meeting of the International Centers for Tropical Disease Research, National Institutes of Health, Bethesda, Maryland, April 22, 1996. The S-Plus computer code for the mixed model algorithm, developed by Drs. J. Pinheiro, D. Bates, and M. Lindstrom, was obtained from STATLIB. We thank Dr. M. D. Chestnut for her helpful comments, Dr. C. Bern and Mrs. J. Abed for editorial assistance, and Ms. J. B. Phu and Ms. D. Sara for technical assistance.

Keywords

  • Cryptosporidium parvum
  • Diarrhea, infantile
  • Growth disorders
  • Infection
  • Longitudinal studies
  • Nutrition disorders
  • Smoothing splines
  • Statistics

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