First Detected Helicobacter pylori Infection in Infancy Modifies the Association Between Diarrheal Disease and Childhood Growth in Peru. Issue 4 (20th April 2014) - Jaganath, Devan
Abstract Background In endemic settings, Helicobacter pylori infection can occur shortly after birth and may be associated with a reduction in childhood growth. Materials and Methods This study investigated what factors promote earlier age of first H. pylori infection and evaluated the role of H. pylori infection in infancy (6–11 months) versus early childhood (12–23 months) on height. We included 183 children near birth from a peri‐urban shanty town outside of Lima, Peru. Field‐workers collected data on socioeconomic status (SES), daily diarrheal and breast‐feeding history, antibiotic use, anthropometrics, and H. pylori status via carbon 13‐labeled urea breath test up to 24 months after birth. We used a proportional hazards model to assess risk factors for earlier age at first detected infection and linear mixed‐effects models to evaluate the association of first detected H. pylori infection during infancy on attained height. Results One hundred and forty (77%) were infected before 12 months of age. Lower SES was associated with earlier age at first detected H. pylori infection (low vs middle‐to‐high SES Hazard ratio (HR) 1.59, 95% CI 1.16, 2.19; p = .004), and greater exclusive breast‐feeding was associated with reduced likelihood (HR 0.63, 95% CI 0.40, 0.98, p = .04). H. pylori infection in infancy was not independently associated with growth deficits (p = .58). However, children who had their first detected H. pylori infection in infancy (6–11 months) versus early childhood (12–23 months) and who had an average number of diarrhea episodes per year (3.4) were significantly shorter at 24 months (−0.37 cm, 95% CI, −0.60, −0.15 cm; p = .001). Discussion Lower SES was associated with a higher risk of first detected H. pylori infection during infancy, which in turn augmented the adverse association of diarrheal disease on linear growth.