Association of vitamin D status with incidence of enterotoxigenic, enteropathogenic and enteroaggregative Escherichia coli diarrhoea in children of urban Bangladesh

Objective To evaluate the association between vitamin D status and diarrheal episodes by enterotoxigenic (ETEC) enteropathogenic (EPEC) and enteroaggregative (EAEC) E. coli in underweight and normal-weight children aged 6-24 months in urban Bangladesh. Methods Cohorts of 446 normal-weight and 466 underweight children were tested separately for ETEC EPEC and EAEC from diarrheal stool samples collected during 5 months of follow-up while considering vitamin D status at enrolment as the exposure. Cox proportional hazards models with unordered failure events of the same type were used to determine diarrheal risk factors after adjusting for sociodemographic and concurrent micronutrient status. results Vitamin D status was not independently associated with the risk of incidence of ETEC EPEC and EAEC diarrhea in underweight children but moderate-to-severe retinol de ciency was associated with reduced risk for EPEC diarrhea upon adjustment. Among normal-weight children insuf cient vitamin D status and moderate-to-severe retinol de ciency were independently associated with 44% and 38% reduced risk of incidence of EAEC diarrhea respectively. These children were at higher risk of ETEC diarrhea with vitamin D de ciency status when adjusted for micronutrient status only. Conclusion This study demonstrates for the rst time that normal-weight children with insuf cient vitamin D status have a reduced risk of EAEC diarrhea than children with suf cient status. Moderate-to-severe de ciency of serum retinol is associated with reduced risk of EPEC and EAEC diarrhea in underweight and normal-weight children.