H. PYLORI COLONISATION AND GROWTH IN
INFANCY
Bunn
JEG1,3 Thomas JE2,3 Harding M3
Coward WA3 Cole T3 Weaver LT3,4
1Liverpool
School Tropical Medicine, Liverpool, UK, 2Dept Child Health,
University of Newcastle, UK, 3MRC Dunn Nutrition Unit,
Cambridge, UK, 4Dept Child Health, University of Glasgow, UK
Objective: To compare the growth of
Gambian children colonised with Helicobacter
pylori early in infancy, with those who remained uncolonised or were
colonised later in infancy.
Methods: Follow up of a birth
cohort of 65 rural Gambian infants to one year. Infants had monthly 13C
urea breath tests (UBT) from 12-52 weeks to diagnose and determine
established H. pylori
colonisation (defined as three
consecutive positive UBTs), and monthly anthropometry to assess
growth.
Results: 29 infants had established
colonisation before 32 weeks of life, and their growth was compared with
the other 36 infants. Birth weight (2.84 vs. 2.83Kg), length and head
circumference were similar for both groups. By one year infants colonised
before 32 weeks had lower mean weights (WAZ difference 0.49, p<0.05),
and length (HAZ difference 0.44, p=0.10). Mean head circumference (HC) was 7.7mm smaller
(p<0.05), mid upper arm
circumference (MUAC) 0.64mm thinner (p<0.05), and triceps skin fold
(SFT) 0.39mm less. Weight differences preceded length and HC differences.
Socio-economic differences were minimal, and seasonal factors insufficient
to explain this association.
When 49 (75%) of
these infants were followed up at 5 years of age, WAZ scores and HAZ scores
were within the same range.
Conclusion: Colonisation with H. pylori in The Gambia occurs
early, and was associated with significant growth faltering during the
first year of life. Although these growth differences appeared to have
disappeared by 5 years of age, the impact on morbidity and mortality of an
adverse WAZ score in early life are well recognised. If this growth
impairment in infants is confirmed, H
pylori infection in infancy may contribute significantly to childhood
morbidity and mortality world-wide.