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Environmental enteric dysfunction

Sophie Budge, Alison H Parker, Paul T Hutchings, Camila Garbutt
In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting...
February 7, 2019: Nutrition Reviews
Lerner Aaron, Matthias Torsten, Wusterhausen Patricia
Celiac disease is an autoimmune condition of the small intestine caused by prolamins in genetically susceptible individuals evoked by multiple environmental factors. The pathological luminal intricate eco-events produce multiple signals that irradiate the entire body, resulting in a plethora of extra-intestinal manifestations. Nutrients, dysbiosis, dysbiotic components and their mobilome, post-translational modification of naive proteins, inter-enterocyte's tight junction dysfunction resulting in a leaky gut, microbial lateral genetic transfer of virulent genes, the sensing network of the enteric nervous systems and the ensuing pro-inflammatory messengers are mutually orchestrating the autoimmune interplay...
January 10, 2019: Autoimmunity Reviews
Luther A Bartelt, David T Bolick, Richard L Guerrant
Environmental enteric dysfunction (EED, syn. environmental enteropathy (EE)) is a subclinical chronic intestinal disorder that is an emerging contributor to early childhood malnutrition. EED is common in resource-limited settings, and is postulated to consist of small intestinal injury, dysfunctional nutrient absorption, and chronic inflammation that results in impaired early child growth attainment. While there is emerging interest in the hypothetical potential for chemical toxins in the environmental 'exposome' to contribute to EED, the propensity of published data, and hence the focus of this review, implicates a critical role of environmental microbes...
January 7, 2019: Cellular and Molecular Gastroenterology and Hepatology
Mauro Batista de Morais, Giselia Alves Pontes da Silva
OBJECTIVE: To describe the current indicators of environmental enteric dysfunction and its association with linear growth deficit and the height-for-age anthropometric indicator. DATA SOURCES: Narrative review with articles identified in PubMed and Scopus databases using combinations of the following words: environmental, enteric, dysfunction, enteropathy, and growth, as well as the authors' personal records. DATA SYNTHESIS: In the last 15 years, new non-invasive markers have been investigated to characterize environmental enteric dysfunction; however, the best tests to be used have not yet been identified...
January 7, 2019: Jornal de Pediatria
Julie M Long, Prasenjit Mondal, Jamie E Westcott, Leland V Miller, M Munirul Islam, Mondar Ahmed, Mustafa Mahfuz, Tahmeed Ahmed, Nancy F Krebs
Background: Environmental enteric dysfunction (EED), a chronic inflammatory disorder of the small bowel, is suspected to impair absorption of micronutrients, including zinc. Objective: The objective of this study was to compare zinc absorption from micronutrient powder (MNP) over a range of zinc doses in young children screened for EED with use of the lactulose:mannitol ratio (L:M). Methods: Bangladeshi children aged 18-24 mo, grouped according to high and low L:M (≥0...
January 9, 2019: Journal of Nutrition
Yankho Kaimila, Ryan T Pitman, Oscar Divala, D Taylor Hendrixson, Kevin B Stephenson, Sophia Agapova, Indi Trehan, Ken Maleta, Mark J Manary
Malnutrition in children is most often attributed to inadequate nutrient intake. Utilizing data from two prospective, randomized control trials of complimentary feeding with supplemental legumes (n = 693, ages 6-24 months) in two Malawian villages, Masenjere, and Limera, we document a high rate 70/693 (10.1%) of acute malnutrition (AM). Risks for AM in this setting, as determined by cox-regression analysis, include study village (Hazard ratio (HR) 3.0), prior malnutrition (HR 4.12), stunting (HR 2.87), and a marker of food insecurity (HR 1...
December 14, 2018: Journal of Pediatric Gastroenterology and Nutrition
Julia de Bruyn, Peter C Thomson, Ian Darnton-Hill, Brigitte Bagnol, Wende Maulaga, Robyn G Alders
There is substantial current interest in linkages between livestock-keeping and human nutrition in resource-poor settings. These may include benefits of improved diet quality, through animal-source food consumption and nutritious food purchases using livestock-derived income, and hazards of infectious disease or environmental enteric dysfunction associated with exposure to livestock feces. Particular concerns center on free-roaming chickens, given their proximity to children in rural settings, but findings to date have been inconclusive...
November 19, 2018: Nutrients
Scott B Ickes, Muttaquina Hossain, Gaelen Ritter, Monica Lazarus, Katie Reynolds, Baitun Nahar, Tahmeed Ahmed, Judd Walson, Donna M Denno
Child undernutrition has multifactorial causes, ranging from food insecurity to etiologies refractory to conventional nutritional approaches, such as infections, environmental enteric dysfunction, and other conditions that lead to systemic inflammation. Poor appetite may be an important symptom of these causes and may be a useful marker of an undernourished child's ability to recover. We conducted a systematic review to characterize the methods and tools to measure appetite among children <5 y old in low- and middle-income countries...
November 1, 2018: Advances in Nutrition
Jacqueline M Lauer, Christopher P Duggan, Lynne M Ausman, Jeffrey K Griffiths, Patrick Webb, Bernard Bashaasha, Edgar Agaba, Florence M Turyashemererwa, Shibani Ghosh
Environmental enteric dysfunction (EED), a subclinical disorder of the small intestine, and poor growth are associated with living in poor water, sanitation, and hygiene (WASH) conditions, but specific risk factors remain unclear. Nested within a birth cohort study, this study investigates relationships among water quality, EED, and growth in 385 children living in southwestern Uganda. Water quality was assessed using a portable water quality test when children were 6 months, and safe water was defined as lacking Escherichia coli contamination...
October 22, 2018: American Journal of Tropical Medicine and Hygiene
Jacqueline M Lauer, Christopher P Duggan, Lynne M Ausman, Jeffrey K Griffiths, Patrick Webb, Edgar Agaba, Nathan Nshakira, Hao Q Tran, Andrew T Gewirtz, Shibani Ghosh
Background: Adverse birth outcomes, including preterm birth and stunting at birth, have long-term health implications. The relation between adverse birth outcomes and chronic, asymptomatic gastrointestinal inflammation (environmental enteric dysfunction-EED) is poorly understood. Objective: We aimed to examine the relation between maternal EED and adverse birth outcomes in a sample of pregnant Ugandan women and their newborn infants. Design: We conducted a prospective cohort study in Mukono, Uganda...
October 1, 2018: American Journal of Clinical Nutrition
Pedro Henrique Q S de Medeiros, Daniel V Pinto, Juliana Zani de Almeida, Juliana M C Rêgo, Francisco A P Rodrigues, Aldo Ângelo M Lima, David T Bolick, Richard L Guerrant, Reinaldo B Oriá
The micronutrient vitamin A refers to a group of compounds with pleiotropic effects on human health. These molecules can modulate biological functions, including development, vision, and regulation of the intestinal barrier. The consequences of vitamin A deficiency and supplementation in children from developing countries have been explored for several years. These children live in an environment that is highly contaminated by enteropathogens, which can, in turn, influence vitamin A status. Vitamin A has been described to modulate gene expression, differentiation and function of diverse immune cells; however, the underlying mechanisms are not fully elucidated...
August 21, 2018: Nutrients
Shah Mohammad Fahim, Subhasish Das, Md Amran Gazi, Mustafa Mahfuz, Tahmeed Ahmed
OBJECTIVE: Environmental Enteric Dysfunction (EED) can be assessed by faecal biomarkers such as Myeloperoxidase (MPO), Neopterin (NEO) and Alpha-1 anti-trypsin (AAT). We aimed to test the association of intestinal pathogens with faecal markers of EED among slum-dwelling children in first 2 years of life. METHODS: The MAL-ED birth cohort data of Bangladesh site were used to conduct this analysis. Multivariable analyses using Generalized Estimating Equations (GEE) were performed to test the association between intestinal pathogens and faecal markers of EED...
August 22, 2018: Tropical Medicine & International Health: TM & IH
M Isabel Ordiz, Karl Wold, Yankho Kaimila, Oscar Divala, Madeline Gilstrap, Henry Z Lu, Mark J Manary
Recent studies have suggested that environmental enteric dysfunction can be assessed in rural African children by measuring levels of fecal mRNA transcripts. The field collection of fecal samples is less invasive and cumbersome than administration of the lactulose:mannitol test, which is typically used to assess environmental enteric dysfunction. This study sought to determine if, as in children aged 12-60 months, an array of seven fecal host transcripts (CD53, CDX1, HLA-DRA, TNF, S100A8, MUC12, and REG1A) could predict environmental enteric dysfunction in rural African infants...
August 2018: Experimental Biology and Medicine
Robert H J Bandsma, Kamran Sadiq, Zulfiqar A Bhutta
BACKGROUND: Persistent diarrhoea (PD), defined as diarrhoeal symptoms for longer than 2 weeks, still forms a substantial disease burden in children under 5 years of age. This article provides an overview of the current knowledge of PD and discusses novel concepts. METHODS: A literature search on PD was performed which focused on evidence on epidemiology, pathophysiology and management of the disease. RESULTS: The prevalence of PD has potentially decreased over the last decades...
August 6, 2018: Paediatrics and International Child Health
Marianne S Morseth, Tor A Strand, Liv Elin Torheim, Ram K Chandyo, Manjeswori Ulak, Sanjaya K Shrestha, Binob Shrestha, Sigrun Henjum
BACKGROUND: Nutrient deficiencies limit the growth and turnover of intestinal mucosa, but studies assessing whether specific nutrients protect against or improve environmental enteric dysfunction (EED) are scarce. We aimed to investigate associations between nutrient intake and EED assessed by lactulose:mannitol (L:M) ratio, anti-1-antitrypsin, myeloperoxidase (MPO), and neopterin (NEO) among children 9-24 months in Bhaktapur, Nepal. METHODS: Among 231 included children, nutrient intake was assessed monthly by 24 h recalls, and 3-month usual intake was estimated using Multiple Source Method...
July 20, 2018: Pediatric Research
Robert E Black, Rebecca Heidkamp
Stunting of linear growth, a highly prevalent problem in children of low- and middle-income countries, is the result of the exposure of the fetus and/or young child to nutritional deficiencies and infectious diseases. Maternal undernutrition results in fetal growth restriction, and infectious diseases in pregnancy can result in preterm delivery. Both of these conditions are important contributors to stunting in early childhood, albeit their relative contribution varies by world region. After birth, growth faltering may begin at 3-5 months of life and becomes more prominent from 6 to 18 months...
2018: Nestlé Nutrition Institute Workshop Series
Chelsea Marie, Asad Ali, Kanta Chandwe, William A Petri, Paul Kelly
Environmental enteric dysfunction (EED) refers to a subclinical disorder of intestinal function common in tropical countries and in settings of poverty and economic disadvantage. The enteropathy that underlies this syndrome is characterized by mucosal inflammation and villus blunting mediated by T cell activation. Epithelial cell disruption and microbial translocation drive systemic inflammation. EED in young children is associated geographically with growth failure, malnutrition, and greatly impaired responses to oral vaccines, notably rotavirus and poliovirus vaccines...
September 2018: Mucosal Immunology
Erica C Borresen, Lei Zhang, Indi Trehan, Nora Jean Nealon, Kenneth M Maleta, Mark J Manary, Elizabeth P Ryan
Background: Environmental enteric dysfunction (EED), frequently seen in rural Malawian children, causes chronic inflammation and increases the risk of stunting. Legumes may be beneficial for improving nutrition and reducing the risk of developing EED in weaning children. Objective: The objectives of this study were to determine the nutritional value, verify the food safety, and identify metabolite profiles of 3 legume-based complementary foods: common bean (CB), cowpea (CP), and traditional corn-soy blend (CSB)...
October 2017: Current developments in nutrition
James A Church, Edward Pk Parker, Margaret N Kosek, Gagandeep Kang, Nicholas C Grassly, Paul Kelly, Andrew J Prendergast
Oral vaccines significantly underperform in low-income countries. One possible contributory factor is environmental enteric dysfunction (EED), a subclinical disorder of small intestinal structure and function among children living in poverty. Here, we review studies describing oral vaccine responses and EED. We identified eight studies evaluating EED and oral vaccine responses. There was substantial heterogeneity in study design and few consistent trends emerged. Four studies reported a negative association between EED and oral vaccine responses; two showed no significant association; and two described a positive correlation...
July 2018: Future Microbiology
Shah Mohammad Fahim, Subhasish Das, Kazi Istiaque Sanin, Md Amran Gazi, Mustafa Mahfuz, M Munirul Islam, Tahmeed Ahmed
Environmental enteric dysfunction (EED) causes gut inflammation and increased intestinal permeability leading to deficiencies in micronutrients such as zinc and iron. Fecal markers such as myeloperoxidase (MPO), neopterin (NEO), and alpha-1-anti-trypsin (AAT) can predict EED. The aim of this study was to examine the association between fecal markers of EED with zinc and iron status among children at first 2 years of life. Malnutrition and Enteric Disease Study Bangladeshi birth cohort data were used to conduct this analysis...
August 2018: American Journal of Tropical Medicine and Hygiene
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