{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T18:12:09Z","timestamp":1779300729870,"version":"3.51.4"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013734","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000}}],"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI127845"],"award-info":[{"award-number":["R01AI127845"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW010923"],"award-info":[{"award-number":["D43 TW010923"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI151214"],"award-info":[{"award-number":["R01AI151214"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K24AI141744"],"award-info":[{"award-number":["K24AI141744"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"\n Background<\/jats:title>\n \n Giardia lamblia<\/jats:italic>\n (\n Giardia<\/jats:italic>\n ) is one of the most common intestinal parasitic infections globally, with an estimated 280 million symptomatic infections annually. In children from low- and middle-income countries (LMICs),\n Giardia<\/jats:italic>\n is highly prevalent and has been associated with loss of intestinal barrier function, nutrient-metabolic dysregulation, and linear growth impairment, but specific mechanisms linking\n Giardia<\/jats:italic>\n to these outcomes remain poorly understood.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and results<\/jats:title>\n \n We used data and samples from a subset of 76 children in a longitudinal birth cohort in Nicaragua to evaluate the natural history and geospatial distribution of\n Giardia<\/jats:italic>\n infections, child growth outcomes (weight-for-age [WAZ] and length-for-age [LAZ] z scores), and relationships with established biomarkers of inflammation, intestinal damage, and growth-signaling. During the first 36 months of life, we tested 2,305 stools (1,903 surveillance stools and 402 diarrheal stools) for\n Giardia<\/jats:italic>\n by qPCR. The incidence of\n Giardia<\/jats:italic>\n -positive stools was 59.6 per 100 child-years. Any detection of\n Giardia<\/jats:italic>\n was associated with a reduction in LAZ at 36 months of life (\u03b2:-0.16,\n P<\/jats:italic>\n \u2009=\u20090.042). This effect increased when considering persistent or recurrent\n Giardia<\/jats:italic>\n detections (\u03b2:-0.26,\n P<\/jats:italic>\n =<0.001) as well as living in a high-density\n Giardia<\/jats:italic>\n detection area (\u03b2:-0.44, P=<0.001). Among intestinal markers,\n Giardia<\/jats:italic>\n was associated with lower median fecal neopterin (a marker of chronic intestinal T cell activation) at 24 and 36 months of age. Among serum systemic biomarkers measured at 24 months,\n Giardia<\/jats:italic>\n detections were associated with indicators of intestinal epithelial cell damage (higher median Intestinal Fatty Acid Binding Protein (\n P<\/jats:italic>\n \u2009=\u20090.002) and Anti-FliC IgA (P\u2009=\u20090.033), and reduced growth-signaling hormone (lower median Insulin-like Growth Factor (IGF-1) (\n P<\/jats:italic>\n \u2009=\u20090.005).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Giardia<\/jats:italic>\n detection was negatively associated with linear growth in an exposure-dependent manner. Simultaneously,\n Giardia<\/jats:italic>\n was associated with diminished serum growth-signaling hormones. Patterns of serum and fecal intestinal biomarkers suggest that\n Giardia-<\/jats:italic>\n mediated epithelial disruption is dissociated from markers of intestinal inflammation.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013734","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T17:44:07Z","timestamp":1778867047000},"page":"e0013734","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Natural history and impact of Giardia lamblia on child growth attainment and associated pathway-specific biomarkers in a Nicaraguan birth cohort"],"prefix":"10.1371","volume":"20","author":[{"given":"Lester","family":"Guti\u00e9rrez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadja 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K.M.","family":"Choy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filem\u00f3n","family":"Bucardo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Vilchez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7808-2507","authenticated-orcid":true,"given":"Sylvia","family":"Becker-Dreps","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luther A.","family":"Bartelt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"issue":"1","key":"pntd.0013734.ref001","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1128\/CMR.00067-12","article-title":"Transmission and epidemiology of zoonotic protozoal diseases 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