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Despite the absence of symptoms, these infections are associated with impaired growth and nutritional deficiencies, potentially increasing the risk of stunting, wasting, and underweight. This study examined the association between asymptomatic\n                      <jats:italic>Cryptosporidium<\/jats:italic>\n                      infection and nutritional status in children under 2 years old.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This is a secondary analysis of data from the MAL-ED study which is a longitudinal birth cohort study conducted in eight countries: Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, and Tanzania, a multi-country investigation of enteric infections and malnutrition. We excluded Pakistan due to the lack of available anthropometric data. Nutritional indicators were assessed using the World Health Organization growth chart,[18] including stunting (length-for-age &lt;-2 standard deviations [SD]), underweight (weight-for-age &lt;-2 SD), and wasting (weight-for-length &lt;-2 SD). Poisson regression estimated\n                      <jats:italic>Cryptosporidium incidence<\/jats:italic>\n                      rates, while GEE (generalized estimation equation) with a binomial family and logit link assessed associations with nutritional indicators, calculating odds ratios.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      Findings indicate an incidence rate of 7.89 per 100 child-months for asymptomatic\n                      <jats:italic>Cryptosporidium<\/jats:italic>\n                      infections, which are significantly associated with stunting (aOR: 1.32; 95% CI: 1.24\u20131.41), wasting (aOR: 1.47; 95% CI: 1.08\u20131.49), and underweight (aOR: 1.47; 95% CI: 1.08\u20131.49). Incidence was highest in Tanzania (14.35) and Peru (12.55), indicating a hidden burden, while Brazil (1.34) had the lowest. Stunting was strongly associated with infection in India, Peru, and Tanzania, underweight in Bangladesh and Tanzania, and wasting was notably high in Peru.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This study highlights the significant burden of asymptomatic\n                      <jats:italic>Cryptosporidium<\/jats:italic>\n                      infections and their potential impact on child growth and nutrition. The strong associations with stunting, wasting, and underweight suggest that even in the absence of symptoms, these infections may contribute to long-term developmental challenges. Furthermore, the differential effects on nutritional outcomes across countries emphasize the importance of targeted strategies to mitigate the hidden consequences of\n                      <jats:italic>Cryptosporidium<\/jats:italic>\n                      infections and improve child health globally.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40795-025-01183-2","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:04:03Z","timestamp":1761044643000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of asymptomatic Cryptosporidium infection on nutritional status in children under two: a multi-country cohort study"],"prefix":"10.1186","volume":"11","author":[{"given":"Murad Alam","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Ahshanul","family":"Haque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md.","family":"Tariqujjaman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ASG","family":"Faruque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahmeed","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Mahfuz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"issue":"7","key":"1183_CR1","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1086\/591539","volume":"47","author":"SM Mor","year":"2008","unstructured":"Mor SM, Tzipori S. 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Lancet Glob Health. 2018;6(7):e758\u201368.","journal-title":"Lancet Glob Health"}],"container-title":["BMC Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-025-01183-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40795-025-01183-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-025-01183-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T23:05:11Z","timestamp":1761087911000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcnutr.biomedcentral.com\/articles\/10.1186\/s40795-025-01183-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1183"],"URL":"https:\/\/doi.org\/10.1186\/s40795-025-01183-2","relation":{},"ISSN":["2055-0928"],"issn-type":[{"value":"2055-0928","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]},"assertion":[{"value":"27 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study involves secondary data analysis of the MAL-ED multi-country birth cohort study and was approved by the Research Review Committee and the Ethical Review Committee, two integral components of the Institutional Review Board of icddr, b. The protocol approval number for this study is PR-20129. The original MAL-ED study was approved by the Research Review Committee and the Ethical Review Committee of icddr, b (Bangladesh); the Local Institutional Review Board at the Federal University of Cear\u00e1 and the national IRB Conselho Nacional de \u00c9tica em Pesquisa (Brazil); the Christian Medical College Institutional Review Board and the Emory University Institutional Review Board (India); the Nepal Health Research Council and Walter Reed Institute of Research (Nepal); the Ethics Committee of Asociaci\u00f3n Ben\u00e9fica PRISMA, the Regional Health Directorate of Loreto, and the IRB of Johns Hopkins Bloomberg School of Public Health (Peru); the Ethical Review Committee of Aga Khan University (Pakistan); the Institutional Review Board at the University of Venda (South Africa); the National Institute for Medical Research (Tanzania); and the Institutional Review Board of the University of Virginia (USA).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Written informed consent was obtained from the parents or legal guardians of each child prior to data collection. All methods were performed in accordance with relevant guidelines and regulations, and the study was conducted in compliance with the principles of the Declaration of Helsinki(WMA, 2013). All assays were conducted as part of the MAL-ED study, with no additional assays or sample collection performed.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Not Applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}},{"value":"Murad Alam Khan, Md. Ahshanul Haque contributed equally to this work.Md. Tariqujjaman, ASG Faruque, Tahmeed Ahmed, Mustafa Mahfuz, agreed to review the final version of the manuscript.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author information"}}],"article-number":"190"}}