Does Childhood Diarrhea Influence Cognition Beyond the Diarrhea-Stunting Pathway?

• Type of Material: Article
• Authors: Christa L. Fischer Walker, Johns Hopkins Bloomberg School of Public Health; Laura Lamberti, Johns Hopkins Bloomberg Sch Publ Hlth; Linda Adair, University of North Carolina; Richard L. Guerrant, University of Virginia; Andres G. Lescano, U.S. Naval Medical Research Unit No. 6 (NAMRU-6); Reynaldo Martorell, Emory University; Relana C. Pinkerton, University of Virginia; Robert E. Black, Johns Hopkins Bloomberg School of Public Health
• Language: English
• Date: 2012-10-31
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0047908
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 7
• Issue: 10
• Start Page: e47908
• End Page: e47908
• Grant/Funding Information: The participation of Dr. Lescano in this project is sponsored by the training grant NIH/FIC 2D43 TW007393 awarded to NAMRU-6 by the Fogarty International Center of the U.S. National Institutes of Health.; The Brazil work was supported by NIH/NIAID ICIDR Grant No. UO1AI026512.; Dr. Fischer Walker, Laura Lamberti, and D. Robert Black were funded by the Bill and Melinda Gates Foundation via the U.S. Fund for UNICEF for the Child Health Epidemiology Reference Group (CHERG).; This work was supported by multiple donors.
• Keywords: DISEASE; NUTRITION; Science & Technology; CHILDREN; MULTIDISCIPLINARY SCIENCES; Science & Technology - Other Topics; MALNUTRITION; Multidisciplinary Sciences; ACHIEVEMENT; BRAZILIAN SHANTYTOWN
• Research Categories: Health Sciences, Nutrition; Biology, Parasitology; Health Sciences, Public Health

Abstract

Background: Diarrhea is a leading cause of morbidity among children under 5 years of age in low- and middle-income countries yet the additional effects and sequelae, such as cognitive impairment associated with diarrhea, have not been quantified. Methods: We quantified the association between diarrhea prevalence and cognitive outcomes while controlling for linear growth in 4 study populations. Cognition was assessed using different methods across sites and was expressed in standardized units. We built linear regression models for each study with standardized cognitive score as the outcome and diarrhea prevalence as the main predictor variable. We then conducted meta-analyses of the regression coefficients to generate pooled estimates of the association between diarrhea prevalence and cognition whilst controlling for anthropometric status and other covariates. Results: Diarrhea was not a significant predictor of cognitive score in any site in the regression models or in the meta-analyses (Coefficient = 0.07; 95% CI: -0.1, 0.2). The length for age Z- score was negatively related to cognition in all sites (0.18; 95% CI: 0.14, 0.21), with coefficients remarkably similar across sites (Coefficient Range: 0.168-0.186). Conclusions: We did not demonstrate an association between diarrhea and cognition with stunting included in the model. The links between diarrhea, stunting, and cognition provide additional rationale for accelerating interventions to reduce diarrhea.