Pneumococcal carriage at age 2 months is associated with growth deficits at age 6 months among infants in South India

Christian L. Coles, Lakshmi Rahmathullah, Reba Kanungo, Joanne Katz, Debora Sandiford, Sheela Devi, R. D. Thulasiraj, James M. Tielsch

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Nasopharyngeal colonization is the first step in the pathway to Streptococcus pneumoniae (Spn) infection, a leading cause of childhood morbidity and mortality. We investigated the effect of Spn colonization at ages 2 and 4 mo on growth at age 6 mo among 389 infants living in rural South India by using data from an Spn carriage study nested within a randomized, double-blind, placebo-controlled community trial designed to evaluate the impact of newborn vitamin A supplementation on Spn carriage in the first 6 mo of life. Primary outcomes were weight, length, and anthropometric indices of nutritional status. Growth data at age 6 mo were available for 84% (389 of 464) of infants in the Spn carriage study. Carriage at age 2 mo was associated with increased odds of stunting [OR: 3.07 (95% CI: 1.29, 7.36) P = 0.012] and lower weight [β: 2266 g (95% CI: 2527, 25) P = 0.045], length [β: 21.31 cm (95% CI: 22.32, 20.31) P = 0.010], and length-for-age Z scores [β: 20.59; (95% CI: 21.05,20.13) P = 0.012] at age 6 mo. Spn carriage at age 4 mo did not affect growth. Carriage of invasive serotypes at age 2 mo was associated with decreases in mean weight [β: 2289 g; (95% CI: 2491, 2106) P = 0.002] and length [b:20.38 cm (95% CI: 21.49, 20.01) P = 0.047] at age 6 mo. Newborn vitamin A supplementation did not modify the association between Spn carriage and growth. Results suggest that pneumococcal carriage at age 2 mo is an independent risk factor for poor growth in young infants. Future studies need to clarify the role of Spn carriage on growth retardation in low-income countries.

Original languageEnglish (US)
Pages (from-to)1088-1094
Number of pages7
JournalJournal of Nutrition
Issue number6
StatePublished - Jun 1 2012

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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