Association between enteropathogens and malnutrition in children aged 6–23 mo in Bangladesh: a case-control study

<b>Background:</b> Early exposure to enteropathogens has been associated with malnutrition in children in low-resource settings. However, the contribution of individual enteropathogens remains poorly defined. Molecular diagnostics offer an increase in sensitivity for detecting enteropathogens but have not been comprehensively applied to studies of malnutrition.<b>Objective:</b> We sought to identify enteropathogens associated with malnutrition in Bangladesh.<b>Design:</b> Malnourished children [weight-for-age <i>z</i> score (WAZ) <-2] aged 6-23 mo in Dhaka, Bangladesh, and identified by active community surveillance were enrolled as cases, and normal-weight children (WAZ >-1) of the same age and from the same community were enrolled as controls. Stools were collected at enrollment and, for cases, after a 5-mo nutritional intervention. Enrollment and follow-up stools were tested by quantitative polymerase chain reaction for 32 enteropathogens with the use of a custom-developed TaqMan Array Card.<b>Results:</b> Enteropathogen testing was performed on 486 cases and 442 controls upon enrollment and 365 cases at follow-up. At enrollment, the detection of enteroaggregative <i>Escherichia coli</i> (OR: 1.39; 95% CI: 1.05, 1.83), <i>Campylobacter</i> spp. (OR: 1.46; 95% CI: 1.11, 1.91), heat-labile enterotoxin-producing <i>E. coli</i> (OR: 1.55; 95% CI: 1.04, 2.33), <i>Shigella</i>/enteroinvasive <i>E. coli</i> (OR: 1.65; 95% CI: 1.10, 2.46), norovirus genogroup I (OR: 1.66; 95% CI: 1.23, 2.25), and <i>Giardia</i> (OR: 1.73; 95% CI: 1.20, 2.49) were associated with malnourished cases, and the total burden of these pathogens remained associated with malnutrition after adjusting for sociodemographic factors. The number of these pathogens at follow-up was negatively associated with the change in WAZ during the intervention (-0.10 change in WAZ per pathogen detected; 95% CI: -0.14, -0.06), whereas the number at enrollment was positively associated with the change in WAZ (0.05 change in WAZ per pathogen detected; 95% CI: 0.00, 0.10).<b>Conclusions:</b> A subset of enteropathogens was associated with malnutrition in this setting. Broad interventions designed to reduce the burden of infection with these pathogens are needed. This trial was registered at clinicaltrials.gov as NCT02441426.