# Influence of Enterocytozoon bieneusi Infection on Child Growth: A Secondary Analysis of the MAL-ED Birth Cohort Study

## TL;DR

This study found that infection with the parasite Enterocytozoon bieneusi is linked to reduced growth and weight in children.

## Contribution

The study provides new evidence that E. bieneusi infection significantly impacts child growth metrics in a large international cohort.

## Key findings

- Infected children had significantly lower length-for-age Z scores compared to noninfected children.
- Weight-for-age and weight-for-length Z scores were also reduced in infected children.
- The results highlight E. bieneusi as a significant contributor to childhood malnutrition.

## Abstract

Malnutrition in the early days of life is a global public health concern that affects children’s growth. It results from a variety of factors, including pathogenic infections. Enterocytozoon bieneusi is a microsporidian parasite that can cause diarrhea and malnutrition in children. The study aimed to assess the impact of E. bieneusi on child growth. The MAL-ED study, a multicountry birth cohort research project, investigated the relationship between enteric infections and malnutrition in participating children from eight countries. A customized real-time polymerase chain reaction-based TaqMan array card was used in this study to identify enteropathogens from stool samples, where E. bieneusi was one of the target pathogens. The impacts of E. bieneusi infection on growth measures were assessed. Mixed-effect linear models were used to investigate the relationship between E. bieneusi and growth outcomes, including length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z scores. At the endpoint (last month of measurement), the infected group had significantly lower scores than the noninfected group for all outcomes. The adjusted difference-in-difference (D-in-D) values were −0.53 (95% CI: −0.67 to −0.38) for LAZ, −0.38 (95% CI: −0.52 to −0.23) for WAZ, and −0.22 (95% CI: −0.38 to −0.06) for WLZ. Enterocytozoon bieneusi infection has been identified as a factor associated with reduced linear growth, weight gain, and weight gain relative to linear growth in children, underscoring the importance of treating this infection.