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Enteric permeability, systemic inflammation and post-discharge growth among a cohort of hospitalized children in Kenya and Pakistan.

Enteric permeability, systemic inflammation and post-discharge growth among a cohort of hospitalized children in Kenya and Pakistan.


Title: Enteric permeability, systemic inflammation and post-discharge growth among a cohort of hospitalized children in Kenya and Pakistan.
Author: Tickell, KD
Denno, DM
Saleem, A
Ali, A
Kazi, Z
Singa, BO
Otieno, C
Mutinda, C
Ochuodho, V
Richardson, BA
... 4 more authors Show all authors
Date: 2022-09-20
Language: English
Scope: 7
Department: Faculty of Physical Sciences
Faculty of Medicine
Series: Journal of Pediatric Gastroenterology and Nutrition; 75(6)
ISSN: 0277-2116
DOI: 10.1097/mpg.0000000000003619
Subject: childhood growth; environmental enteric function; systemic inflammation; Pediatrics, Perinatology and Child Health; Gastroenterology
URI: https://hdl.handle.net/20.500.11815/3871

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Citation:

Tickell , KD , Denno , DM , Saleem , A , Ali , A , Kazi , Z , Singa , BO , Otieno , C , Mutinda , C , Ochuodho , V , Richardson , BA , Ásbjörnsdóttir , KH , Hawes , SE , Berkley , JA & Walson , JL 2022 , ' Enteric permeability, systemic inflammation and post-discharge growth among a cohort of hospitalized children in Kenya and Pakistan. ' , Journal of Pediatric Gastroenterology and Nutrition , vol. 75 , no. 6 , pp. 768-774 . https://doi.org/10.1097/mpg.0000000000003619

Abstract:

Objectives: To determine whether gut permeability is associated with post-discharge growth and systemic inflammation among hospitalized children in low- and middle-income countries. Methods: Children aged 2-23 months being discharged from Civil Hospital Karachi (Pakistan) and Migori County Referral Hospital (Kenya) underwent lactulose-rhamnose ratio (LRR) permeability testing and were compared to age-matched children from their home communities. Linear mixed effect models estimated the associations between LRR among discharged children with change in length-for-age (LAZ) and weight-for-age z score (WAZ) at 45, 90, and 180 days after discharge. Linear regression tested if relationships between LRR, systemic inflammation [C-reative protein (CRP), Cluster of Differentiation 14 (CD14), Tumour Necrosis Factor Alpha (TNFα), Interleukin-6 (IL-6)], and enterocyte damage [Intestinal Fatty-Acid Binding protein (I-FABP)] differed between the hospitalized and community groups. Results: One hundred thirty-seven hospitalized and 84 community participants were included. The hospitalized group had higher log-LRR [0.43, 95% confidence interval (CI): 0.15-0.71, P = 0.003] than the community children. Adjustment for weight-for-length z score at discharge attenuated this association (0.31, 95% CI: 0.00-0.62, P = 0.049). LRR was not associated with changes in WAZ or LAZ in the post-discharge period. Associations between LRR and CRP (interaction P = 0.036), TNFα (P = 0.017), CD14 (P = 0.078), and IL-6 (P = 0.243) differed between community and hospitalized groups. LRR was associated with TNFα (P = 0.004) and approached significance with CD14 (P = 0.078) and IL-6 (P = 0.062) in community children, but there was no evidence of these associations among hospitalized children. Conclusions: Although increased enteric permeability is more prevalent among children being discharged from hospital compared to children in the community, it does not appear to be an important determinant of systemic inflammation or post-discharge growth among hospitalized children.

Description:

Funding Information: Sources of Funding: The CHAIN Network is supported by the Bill & Melinda Gates Foundation [OPP1131320]. For the purpose of Open Access, the authors have applied a CC-BY public copyright license to any author accepted manuscript version arising from this submission. The lactulose-rhamnose testing was funded by an Early Career Award from the Thrasher Research Foundation. The funders had no role in conduct of the study, interpretation, writing the manuscript or decision to submit. No authors were paid to write this article by any company, organization or agency. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

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