Said-Mohamed, RStein, A.DPettifor, J.MNorris, S.A2024-06-092024-06-092019-08Said-Mohamed R, Stein AD, Pettifor JM, Norris SA. Sanitation and diarrhoea in infancy and CRP level at 18 years: the birth-to-twenty plus cohort. Ann Hum Biol. 2019 Aug;46(5):415-424. doi: 10.1080/03014460.2019.1657496.https://doi.org/10.1080/03014460.2019.1657496https://pubmed.ncbi.nlm.nih.gov/31460800/https://hdl.handle.net/11288/596452Background: Cardiometabolic disease is associated with chronic low-grade inflammation. While low birthweight, childhood stunting and rapid weight gain predict higher adult high-sensitivity C-reactive protein (hs-CRP) concentrations, associations between childhood infections and adulthood CRP are inconsistent.Aim: To assess the associations between sanitation, diarrhoea and a combined score of both from birth to age 2 years and hs-CRP at age 18 years, independently of early life nutrition and adult adiposity. Subjects and methods: This study collected data on sanitation and diarrhoea episodes from birth to 2 years on 756 participants of the Birth-to-Twenty Plus cohort, a birth cohort initiated in South Africa in 1990, and calculated a combined score of both variables. Anthropometry was measured at 2 years and 18 years and hs-CRP at 18 years. Results: Of the participants, 29.5% had no access to indoor flush sanitation and 38.2% experienced ≥1 diarrhoea episode between birth and 2 years. Not having access to indoor flush sanitation and experiencing ≥1 diarrhoea episodes were associated with 1.50 mg/L and 1.52 mg/L higher hs-CRP, respectively. Prevalence of both burdens in infancy was associated with a 2.18 mg/L higher hs-CRP.Conclusion: In this population, poor sanitation and diarrhoea in early life predict elevated CRP in young adulthood, independently of early life nutrition and adiposity.enAfricaInfectionAdiposityGrowthLow-grade inflammationArticleAnnals of Human Biology