Fecal microbiota analysis of children with small intestinal bacterial overgrowth among residents of an urban slum in Brazil

Mello, Carolina Santos; Rodrigues, Mirian Silva do Carmo; Araújo Filho, Humberto Bezerra de; Melli, Lígia Cristina Fonseca Lahoz; Tahan, Soraia; Pignatari, Antônio Carlos Campos; Morais, Mauro Batista de

doi:10.1016/j.jped.2017.09.003

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Original articles • J. Pediatr. (Rio J.) 94 (5) • Sep-Oct 2018 • https://doi.org/10.1016/j.jped.2017.09.003 copy

Fecal microbiota analysis of children with small intestinal bacterial overgrowth among residents of an urban slum in Brazil^☆ ☆ Please cite this article as: Mello CS, Rodrigues MS, Filho HB, Melli LC, Tahan S, Pignatari AC, et al. Fecal microbiota analysis of children with small intestinal bacterial overgrowth among residents of an urban slum in Brazil. J Pediatr (Rio J). 2018;94:483-90.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the fecal microbiota composition of children living in an urban slum in Brazil, with or without small intestinal bacterial overgrowth, and to investigate the occurrence of stunting and anemia.

Methods:

A total of 100 children were studied, aged 5-11 years, from the municipality of Osasco, São Paulo. Small intestinal bacterial overgrowth was screened through hydrogen and methane breath test with lactulose. Weight and height were measured, and the height-for-age and body mass-for-age anthropometric indexes were calculated. The occurrence of anemia was investigated by capillary hemoglobin. Analysis of bacterial phylum, genus, and species was performed by real-time polymerase chain reaction in fecal samples.

Results:

Small intestinal bacterial overgrowth was identified in 61.0% of the children. A lower mean of height-for-age Z-score ([−0.48 ± 0.90] vs. [−0.11 ± 0.97]; p = 0.027), as well as capillary hemoglobin ([12.61 ± 1.03 g/dL] vs. [13.44 ± 1.19 g/dL]; p < 0.001) was demonstrated in children with SIBO when compared with children without small intestinal bacterial overgrowth. Children with small intestinal bacterial overgrowth presented a higher frequency of Salmonella spp., when compared to those without small intestinal bacterial overgrowth (37.7% vs. 10.3%; p = 0.002). Higher counts of total Eubacteria (p = 0.014) and Firmicutes (p = 0.038) were observed in children without small intestinal bacterial overgrowth; however, a higher count of Salmonella (p = 0.002) was found in children with small intestinal bacterial overgrowth.

Conclusion:

Children who lived in a slum and were diagnosed with small intestinal bacterial overgrowth showed lower H/A Z-scores and hemoglobin levels. Furthermore, differences were observed in the fecal microbiota of children with small intestinal bacterial overgrowth, when compared to those without it; specifically, a higher frequency and count of Salmonella, and lower counts of Firmicutes and total Eubacteria.

KEYWORDS
Fecal microbiota; Environmental exposure; Child

	SIBO		p
	Yes (n = 61)	No (n = 39)
Age (years)	7.6 (6.4-8.9)	8.2 (6.7-9.9)	0.118^a a Mann-Whitney test, expressed as median (25th and 75th percentiles).
Male gender [n (%)]	61 (58.1%)	14 (46.7%)	0.268^b b Student's t-test (one-tailed analysis), expressed as mean ± standard deviation.
Z-scores
Height/age	-0.48 ± 0.90	-0.11 ± 0.97	0.027^b b Student's t-test (one-tailed analysis), expressed as mean ± standard deviation.
BMI/age	-0.23 ± 1.14	-0.12 ± 1.06	0.320^b b Student's t-test (one-tailed analysis), expressed as mean ± standard deviation.
Capillary hemoglobin (g/dL)	12.61 ± 1.03	13.44 ± 1.19	<0.001^b b Student's t-test (one-tailed analysis), expressed as mean ± standard deviation.
Anemia (Hb < 11.5 g/dL)	8 (13.1%)	2 (5.1%)	0.196^c c Chi-square test.
Running water in the household, n (%)]	26 (42.6%)	28 (71.8%)	0.004^c c Chi-square test.
Sanitary sewer network, n (%)	7 (11.5%)	2 (5.1%)	0.239^d d Fisher's exact test.
Public waste services, n (%)	2 (3.3%)	0 (0.0%)	0.370^d d Fisher's exact test.
Brick house	34 (55.7%)	22 (56.4%)	0.889^c c Chi-square test.
Paved street	9 (14.8%)	3 (7.7%)	0.231^d d Fisher's exact test.

		With SIBO (n = 61)	Without SIBO (n = 39)	p ^a a Mann-Whitney test, expressed as median (25th and 75th percentiles). PPM, parts per million.
H₂	0-60 min	750.0 (528.75-960.0)	472.5 (307.5-712.5)	0.002
	60-180 min	3292.5 (2126.25-4398.75)	2550.0 (1410.0-4080.0)	0.098
	0-180 min	3978.75 (2662.5-5257.5)	2902.50 (1807.50-4800.0)	0.048
CH₄	0-60 min	1072.5 (217.5-1680.0)	840.0 (0.0-1417.5)	0.146
	60-180 min	1920.0 (442.5-4665.0)	1680.0 (0.0-2910.0)	0.081
	0-180 min	2857.5 (630.0-6198.75)	2535.0 (0.0-4327.5)	0.069

		With SIBO (n = 61)	Without SIBO (n = 39)	p ^a a Mann-Whitney test, expressed as median (25th and 75th percentiles).
Total Eubacteria	UFC/g (×10¹⁴)	1.42 (0.26-5.25)	3.62 (0.97-24.68)	0.014
Phylum Bacteroidetes	UFC/g (×10⁹)	1.55 (0.51-2.29)	1.73 (0.50-3.23)	0.344
Bacteroides fragilis	UFC/g (×10¹⁰)	1.08 (0.15-5.16)	2.15 (0.27-14.02)	0.145
Phylum Firmicutes	UFC/g (×10⁸)	0.68 (0.25-2.31)	1.60 (0.52-3.73)	0.038
Lactobacillus spp.	UFC/g (×10⁷)	6.39 (1.66-25.5)	6.51 (2.46-31.93)	0.777
Clostridium difficile	UFC/g (×10³)	0.0 (0.0-1.18)	0.0 (0.0-1.19)	0.956
Clostridium perfringens	UFC/g (×10⁵)	0.49 (0.10-6.30)	0.96 (0.16-5.20)	0.628
Staphylococcus aureus	UFC/g (×10⁵)	0.10 (0.0-4.42)	0.0 (0.0-5.47)	0.672
Bifidobacterium spp.	UFC/g (×10⁵)	5.63 (0.97-31.93)	3.18 (0.64-10.96)	0.249
Salmonella spp.	UFC/g (×10²)	0.0 (0.0-1.64)	0.0 (0.0-0.0)	0.002
Escherichia coli	UFC/g (×10⁹)	1.08 (0.19-9.74)	1.50 (0.38-33.47)	0.381
Methanobrevibacter smithii	UFC/g (×10⁷)	4.18 (1.15-8.71)	2.24 (0.57-9.31)	0.347

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[1] * Corresponding author.E-mail:maurobmorais@gmail.com (M.B. de Morais).