Environmental Enteric Dysfunction: An Overview

Crane, Rosie J; Jones, Kelsey; Berkley, James A.

doi:10.1177/15648265150361s113

Cited by 198 publications

(218 citation statements)

References 94 publications

(106 reference statements)

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“…Thirdly, in addition to infection, there a range of other conditions such as environmental enteric dysfunction (EED), recent vaccinations, cooking with biomass fuels and exposure to toxins that may elicit an acute phase response [4,8]. EED, previously known as environmental enteropathy or tropical enteropathy, might play an important role as it is believed to be highly prevalent in low-and middle income countries [35]. It is a usually asymptomatic condition characterized by inflammation, altered gut structure and function and is associated with stunting in infants and children [35,36].…”

Section: Discussionmentioning

confidence: 99%

Children with moderate acute malnutrition have inflammation not explained by maternal reports of illness and clinical symptoms: a cross-sectional study in Burkina Faso

et al. 2016

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Background: Morbidity plays an important role in the development of and recovery from malnutrition. Morbidity in children with moderate acute malnutrition (MAM) has not been described in detail and it is unclear how morbidity compares to serum levels of acute phase proteins (APPs) which indicate systemic inflammation and which can impede response to therapeutic nutritional interventions. The objective of this study was to describe morbidity in children with MAM and to assess to what extent maternally reported and clinically diagnosed morbidity explain the variation in APPs. Methods: A cross-sectional sub study was conducted as part of a nutrition intervention trial among 6-23 months old children with MAM residing in Burkina Faso. Morbidity data collection at baseline included 2 week maternal recalls and physical examinations. Multivariate ANCOVA models were used to explore the associations between morbidity and C-reactive protein (CRP) as well as α 1 -acid glycoprotein (AGP). These models were also used to determine to what extent morbidity explains variation in APPs.

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Section: Discussionmentioning

confidence: 99%

Children with moderate acute malnutrition have inflammation not explained by maternal reports of illness and clinical symptoms: a cross-sectional study in Burkina Faso

et al. 2016

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“…It is now thought that EED is an important component of the link between poor environmental conditions and reduced height, and a cause of the limited success of nutritional interventions in overcoming this growth deficit in many populations 11 . Although stunting in itself is not particularly harmful to the individual, it is a highly visible manifestation of the effect of EED, and correlates with a much wider range of poor socio economic outcomes, including poor performance in education, reduced income in adulthood and increased fertility 1,[11][12][13] . Earlier diagnosis of EED, even in infants or very young children, could enable targeted interventions.…”

Section: Eedmentioning

confidence: 99%

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Thompson

Hughes

Anastasova

et al. 2017

Nat Rev Gastroenterol Hepatol

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| Environmental enteric dysfunction (EED) is a disease of the small intestine affecting children and adults in low and middle income countries. Arising as a consequence of repeated infections, gut inflammation results in impaired intestinal absorptive and barrier function, leading to poor nutrient uptake and ultimately to stunting and other developmental limitations. Progress towards new biomarkers and interventions for EED is hampered by the practical and ethical difficulties of cross-validation with the gold standard of biopsy and histology. Optical biopsy techniques -which can provide minimally invasive or noninvasive alternatives to biopsy -could offer other routes to validation and could potentially be used as point-of-care tests among the general population. This Consensus Statement identifies and reviews the most promising candidate optical biopsy technologies for applications in EED, critically assesses them against criteria identified for successful deployment in developing world settings, and proposes further lines of enquiry. Importantly, many of the techniques discussed could also be adapted to monitor the impaired intestinal barrier in other settings such as IBD, autoimmune enteropathies, coeliac disease, graft-versus-host disease, small intestinal transplantation or critical care. Members of the board and experts met to discuss the horizon scan in London, UK, in November 2015 and San Francisco, USA, in February 2016. Literature searches were performed using Web of Science, as well as through the advice of the advisory board and experts. The results of the horizon scan are presented in this Consensus Statement, which entails a review of EED, a discussion of technologies deemed relevant to EED (based on literature searches and the opinions of the advisory board and experts), and a series of recommendations for the future application of the rele vant technologies to the study and diagnosis of EED. In the Recommendations section, each technology has been assessed according to its suitability for application to EED and this assessment includes an evaluation of the cost, invasiveness and appropriateness for developing countries of each device and/or technique. This assessment was performed in a qualitative manner based on currently available information (for example, the present cost and size of the devices) and the opinions of the authors as to feasible future develop ment. Technique suitability for use in developing countries was determined in a qualitative manner after consideration of the need for advanced infrastructure and high levels of training for either system use or data analysis. Probable deployment time scales have also been assigned to each technique based on the current states of development and the degree of valid ation work that will be required before application to EED. These timescales have been tentatively defined as short-term (suitable for deployment immediately or within ~1 year), mediumterm (suit able for deployment within ~1-3 years) and long-term (suitable for deployme...

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“…Exposure to pathogens in the environment, which results in environmental enteric dysfunction, has been implicated in the pathogenesis of chronic undernutrition and is being investigated in clinical and community settings. 39 Together with recent trials studying the not-yetunderstood effects of food aid on intergenerational undernutrition, these efforts represent a shift in research priorities toward elucidating the underlying determinants of undernutrition.…”

Section: Strengthening the Evidence Basementioning

confidence: 99%

Making Food Aid Fit-for-Purpose in the 21st Century: A Review of Recent Initiatives Improving the Nutritional Quality of Foods Used in Emergency and Development Programming

2017

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Important strides have been made recently in upgrading the global food aid agenda in line with evolving medical and nutrition sciences, operational experience, and innovations in food technology. A 2011 report endorsed by the United States Agency for International Development (USAID) recommended numerous improvements to products intended to support improved survival and nutrition in humanitarian programming, as well as greater rigor and transparency in the research agenda that supports innovations in this critical field. This article reviews progress since 2011 made by USAID, and other global food aid providers, in developing food aid products that are fit-for-purpose and are appropriately formulated to save lives in emergencies and to promote healthy mothers and children in nonemergency contexts. It highlights important modifications and addition made to products and identifies persisting knowledge gaps that should be prioritized in future research.

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Environmental Enteric Dysfunction: An Overview

Abstract: Background. Environmental enteric dysfunction (EED) refers to an incompletely defined syndrome of inflam

Cited by 198 publications

References 94 publications

Children with moderate acute malnutrition have inflammation not explained by maternal reports of illness and clinical symptoms: a cross-sectional study in Burkina Faso

Children with moderate acute malnutrition have inflammation not explained by maternal reports of illness and clinical symptoms: a cross-sectional study in Burkina Faso

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Making Food Aid Fit-for-Purpose in the 21st Century: A Review of Recent Initiatives Improving the Nutritional Quality of Foods Used in Emergency and Development Programming

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