Protection against Diarrhea Associated with Giardia intestinalis Is Lost with Multi-Nutrient Supplementation A Study in Tanzanian Children 英文参考文献.docVIP

ProtectionagainstDiarrheaAssociatedwithGiardia intestinalisIsLostwithMulti-NutrientSupplementation: AStudyinTanzanianChildren JacobienVeenemans1,TheoMank2,MaartenOttenhof1,3,AmrishBaidjoe2,ErastoV.Mbugi3,AyseY. Demir4,JosP.M.Wielders4,HuubF.J.Savelkoul1,HansVerhoef1,5* 1Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands, 2Department of Parasitology, Public Health Laboratory, Haarlem, The Netherlands,3MuhimbiliUniversityofHealthandAlliedSciences,DaresSalaam,Tanzania,4LaboratoryforClinicalChemistryandHaematology,MeanderMedicalCentre, Amersfoort,TheNetherlands,5LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom Abstract Background:AsymptomaticcarriageofGiardiaintestinalisishighlyprevalentamongchildrenindevelopingcountries,and evidence regarding its role as a diarrhea-causing agent in these settings is controversial. Impaired linear growth and cognitionhavebeenassociatedwithgiardiasis,presumablymediatedbymalabsorptionofnutrients.Inaprospectivecohort study,weaimtocomparediarrhearatesinpre-schoolchildrenwithandwithoutGiardiainfection.Becausethestudywas conductedinthecontextofaninterventiontrialassessingtheeffectsofmulti-nutrientsonmorbidity,wealsoassessedhow supplementationinfluencedtherelationshipbetweenGiardiaanddiarrhoearates,andtowhatextentGiardiamodifiesthe interventioneffectonnutritionalstatus. Methods and Findings: Data were collected in the context of a randomized placebo-controlled efficacy trial with 262 factorial design assessing the effects of zinc and/or multi-micronutrients on morbidity (n=612; height-for-age z-score ,21.5 SD). Outcomes measures were episodes of diarrhea (any reported, or with $3 stools in the last 24h) and fever withoutlocalizingsigns,asdetectedwithhealth-facilitybasedsurveillance.Giardiawasdetectedinstoolbyenzyme-linked immunosorbentassay.Amongchildrenwhodidnotreceivemulti-nutrients,asymptomaticGiardiainfectionatbaselinewas associatedwithasubstantialreductionintherateofdiarrhea(HR0.32;0.15–0.