Abstract
.Small intestine bacterial overgrowth (SIBO) is prevalent among children living in low-income settings, leading to impaired growth and development. The aim of this study was to assess linear and ponderal growth parameters between malnourished SIBO-positive and SIBO-negative children aged 12–18 months who prospectively underwent a nutritional intervention. A glucose hydrogen breath test to detect SIBO was performed in 194 stunted (length-for-age Z score [LAZ] < −2 standard deviations) or at-risk of stunting (LAZ score between < −1 and −2 standard deviations) children. Participants received nutritional supplementation (egg and milk) in addition to their regular family meals 6 days per week for 90 days. Small intestine bacterial overgrowth was defined as a ≥ 12-ppm rise in breath hydrogen over the patient’s baseline during the 3-hour test. Small intestine bacterial overgrowth status before intervention was forced into a multivariable linear regression model to examine its effects on anthropometric changes in response to the intervention. Sociodemographic data at enrollment was analyzed through multivariable logistic regression in an attempt to predict SIBO positivity. Overall, 14.9% (29/194) children were diagnosed with SIBO before the nutritional intervention. No statistically significant difference was observed among SIBO-positive and SIBO-negative groups in terms of their response to the nutritional intervention (SIBO-positive coefficient [95% confidence interval (CI)], P-value for ∆length-for-age Z score −0.003 [−0.14, 0.13], 0.96; ∆weight-for-age Z score −0.05 [−0.20, 0.09], 0.46; and ∆weight-for-length Z score −0.10 [−0.31, 0.10], 0.33). This study demonstrated that a noteworthy proportion of malnourished children living in a disadvantaged urban community were SIBO positive; however, it failed to reveal an association between SIBO status and response to nutritional intervention.
Highlights
METHODSSmall intestine bacterial overgrowth (SIBO) represents an increased number (3 105 colony-forming unit [CFU]/mL) of bacteria present in the upper small intestine.[1]
Several studies have shown that a significant number of children from low- and middle-income countries (LMICs) living in impoverished conditions were SIBO positive as diagnosed by hydrogen breath tests.[2,3]
A study of children aged 6–10 years in Brazil found that 30.9% of lower socioeconomic status children were SIBO positive compared with 2.4% children with increased financial means.[4]
Summary
Small intestine bacterial overgrowth (SIBO) represents an increased number (3 105 colony-forming unit [CFU]/mL) of bacteria present in the upper small intestine.[1] Several studies have shown that a significant number of children from low- and middle-income countries (LMICs) living in impoverished conditions were SIBO positive as diagnosed by hydrogen breath tests.[2,3] A study of children aged 6–10 years in Brazil found that 30.9% of lower socioeconomic status children were SIBO positive compared with 2.4% children with increased financial means.[4] Small intestine bacterial overgrowth has been associated with environmental enteropathy and intestinal inflammation.[5] The prevalence of SIBO among 2-year-old Bangladeshi children was 16.7% based on a recent cross-sectional study which demonstrated an association between linear growth faltering and glucose hydrogen breath test positivity.[5]. Several studies have shown an association between SIBO positivity and lower socioeconomic status and one study demonstrated markers of fecal–oral contamination predicted the presence of SIBO.[2,4,5]
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