Environmental enteropathy: new targets for nutritional interventions

Abstract

In the developing world major public health issues such as malnutrition and compromised physical development are intimately linked to altered gut morphology and function with underlying chronic inflammatory responses. In these societies the downward spiral of malnutrition and infections does not seem to be remedied by well-informed nutritional interventions that supplement the identified nutrient deficiencies, suggesting that additional strategies are needed. The aim of this scientific opinion paper is to consider how a child from the developing world might benefit, separately and additively, from interventions targeted to impact hygiene, nutritional status, disease resistance and gut function, if successful interventions could be found. A failure to tackle environmental enteropathy (EE) may be a critical limiting factor that can explain the relative lack of success of interventions focussed on micronutrient supplementation so far. Therefore this paper starts with a summary of the aetiology and consequences of EE on child health and the current recommendations aimed at tackling this problem. Then a number of hypotheses will be considered in terms of research strategy to positively affect nutritional status, intestinal health and growth of children with EE, with the aim of inspiring future innovative strategies, for both the food industry and the public health sector, which could benefit millions of children.

Poor Folate Status Predicts Persistent Diarrhea in 6- to 30-Month-Old North Indian Children

“…that poor folate status was a consequence of a high burden of diarrheal disease prior to enrollment into the study. A diarrheal infection can lead to decreased dietary intake (27) as well as malabsorption of dietary folate (28) at a time when the requirement for folate by the immune system and the gastrointestinal tract is likely to be higher than normal (29). This adverse effect on folate status could in turn render the child more susceptible to new infections and to acute infections becoming persistent, and it may be that children with high prior diarrheal disease burden were the ones that developed persistent diarrhea during the study period.…”

Habit Formation and Rational Addiction: A Field Experiment in Handwashing

“…We supplement self-reported incidence data with anthropometric outcomes to reduce the likelihood that any observed effects are driven by desirability bias on the part of mothers. Repeated diarrheal disease can affect child weight and height by reducing a child's ability to absorb sufficient nutrients from her food and thereby stunting her growth (McKay et al 2010). We convert these measures into standardized height-for-age, weight-for-age, and midarm-circumference-for-age Z-scores (HAZ, WAZ, and MAZ, respectively) using the methodology provided in the WHO anthropometric guidelines; these Z-scores are calculated (as per WHO methodology) only for children ages 60 months and below (WHO, 2006).…”

Consensus statement understanding health and malnutrition through a systems approach: the ENOUGH program for early life

“…Immune dysfunction may contribute to the high burden of infectious mortality in malnourished children as seen in many poor and unhygienic environments (McKay et al 2010;Verkerke et al 2012). Deficiencies in a number of essential nutrients may impact the innate and adaptive immune system, and supplementation may improve immune responses Maggini et al 2007;Savy et al 2009) depending on genetic makeup and life stage.…”

“…The importance of gut integrity is revealed by small intestinal (or bowel) bacterial overgrowth (SIBO or SBBO), which is associated with failure to thrive and slow growth (Bures et al 2010;Korpe and Petri 2012). SBBO also occurs in environments with poor sanitation and contaminated water (Korpe and Petri 2012) called environmental enteropathy (EE) (McKay et al 2010). The morphological changes in EE are associated with maldigestion, malabsorption of nutrients, and increased intestinal permeability.…”