Tropical Enteropathy (Environmental Enteropathy) in Early Childhood: a Syndrome Caused by Contaminated Environment

Fagundes-Neto, Ulysses; Viaro, T; Wehba, J; Patrı́cio, Francy Reis da Silva; Machado, Nelson Lourenço

doi:10.1093/tropej/30.4.204

Cited by 67 publications

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“…"Tropical enteropathy" with villous shortening, crypt hyperplasia, and lymphocyte infiltration of both lamina propria and epithelium has been confirmed in infants from Gambia (8) and many other developing countries (2,4,10). Elevation of inflammatory markers to levels that would prompt investigation for inflammatory bowel disease in the U.K. (13) is frequently seen, even in seemingly well Gambian children.…”

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“…Protein-energy malnutrition is associated with reduction of regulatory immune responses in the mucosal microenvironment, potentially impairing the mechanisms of oral tolerance. Children from The Gambia show a pattern of growth faltering typical of deprived areas of the developing world (1)(2)(3)(4). Growth velocity falls from 4 mo onward, so by age 2, the mean weight-for-age lies 2 SD below U.K. standards (z score, Ϫ2).…”

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confidence: 99%

“…Quantitatively the most important association identified is small bowel enteropathy (2,4,10), demonstrated by lactulose:mannitol (L:M) dual sugar permeability testing (11). This assesses both epithelial integrity (exclusion of lactulose entry through intercellular tight junctions) and absorptive capacity (passive absorption of mannitol) (12).…”

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Chronic T Cell-Mediated Enteropathy in Rural West African Children: Relationship with Nutritional Status and Small Bowel Function

et al. 2003

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Previous studies from The Gambia have shown that poor childhood growth is resistant to all but the most intense nutritional intervention and highly dependent on small bowel permeability related to enteropathy. We thus aimed to characterize the mucosal inflammatory response in rural Gambian children in relation to intestinal permeability and nutritional status. Small bowel biopsies were taken from 38 rural Gambian children (age, 0.5-3 y) with a range of nutritional and clinical states (median weight z score, Ϫ4.6; range, 0.5 to Ϫ6.4), 75% of whom had diarrhea. Morphometry was performed with immunohistochemical analysis for a range of lineage and activation markers, including proinflammatory and regulatory cytokines, and related to current clinical status and gut permeability. Comparison was made with 19 age-matched U.K. controls. All Gambian children, regardless of nutritional status, had evidence of chronic cellmediated enteropathy with crypt hyperplasia, villous stunting, and high numbers of intraepithelial lymphocytes. CD25ϩ cells were 20-fold higher than in U.K. controls. Although small bowel architecture was independent of nutritional status, T cell numbers rose and B cell numbers fell with worsening nutrition, and mucosal cytokine production became biased toward a proinflammatory response, with progressive decrease of transforming growth factor-␤ expression. Tropical enteropathy predates the onset of marasmus and is characterized by a cell-mediated T H 1 response. Protein-energy malnutrition is associated with reduction of regulatory immune responses in the mucosal microenvironment, potentially impairing the mechanisms of oral tolerance. Children from The Gambia show a pattern of growth faltering typical of deprived areas of the developing world (1-4). Growth velocity falls from 4 mo onward, so by age 2, the mean weight-for-age lies 2 SD below U.K. standards (z score, Ϫ2). Previous studies from Keneba, rural Gambia, have identified biochemical and dietary deficiencies in these infants. Despite seemingly well-targeted nutritional intervention with macroand micronutrients, growth faltering continues (5-9). Massive dietary supplementation (twice recommended values for energy, 2.5 times for protein) produced short-term catch-up growth after gastroenteritis (5), but growth acceleration reached only the population mean, still 2 SD below the U.K., and reversed as soon as the child left the refeeding study (1, 8).The failure of dietary intervention to restore growth has led to search for other factors. Quantitatively the most important association identified is small bowel enteropathy (2, 4, 10), demonstrated by lactulose:mannitol (L:M) dual sugar permeability testing (11). This assesses both epithelial integrity (exclusion of lactulose entry through intercellular tight junctions) and absorptive capacity (passive absorption of mannitol) (12). During a 1-y period, increased L:M ratio accounted for 0031-3998/03/5403-0306 PEDIATRIC RESEARCH Vol. 54, No. 3, 2003 Copyright © 2003 Printed in U.S.A. ABSTRACT306

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Chronic T Cell-Mediated Enteropathy in Rural West African Children: Relationship with Nutritional Status and Small Bowel Function

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“…Uma das anormalidades funcionais descritas foi a má absorção secundária de lactose, presente em metade dos pacientes 12,25 .…”

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“…Por outro lado, como reflexo de condições ambientais e de saneamento básico inadequados, pode estar presente um componente da enteropatia ambiental, que acarreta anormalidades funcionais e morfológicas do intestino delgado 12,13 . Nesta circunstância, pode haver anormalidades na digestão e assimiliação dos nutrientes.…”

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Nutritional status and breath hydrogen test with lactose and lactulose in Terena Indian children

Alves¹,

Fagundes-Neto²,

Morais³

2002

J Pediatr (Rio J)

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Objective: to evaluate the nutritional status, absorption and tolerance of lactose and the occurrence of small-bowel bacterial overgrowth.Methods: a cross-sectional study including all 264 Terena Indian children younger than 10 years from two tribes (Limão Verde and Córrego Seco) in Mato Grosso do Sul. The nutritional status was assessed based upon weight and height, using NCHS data as reference. The breath hydrogen test after an oral lactose (18g) administration was used for evaluation of lactose absorption and tolerance. The occurrence of bacterial overgrowth was evaluated using the breath hydrogen test after the administration of lactulose (5g).Results: the median z scores of weight-for-age, weight-forheight and height-for-age were, respectively, in infants under 1 year (n=34): -0.66, +0.60 and -0.85. Between 1 and 5 years (n=111), the values were: -0.50, +0.28 and -1.17. Between 5 and 10 years (n=119), these anthropometric values were, respectively: -0.09, +0.50 and -0.60. Deficient lactose absorption or malabsorption was verified only after the fourth year of age in 89.3% of the 197 evaluated children. Lactose intolerance was found in 37.1% of them. Small-bowel overgrowth was detected in 11.5% of the Terena Indian children (n=252).Conclusions: the prevalence of recent malnutrition was low, but the median height-for-age was lower than the NCHS reference. The prevalence of ontogenetic lactase deficiency was high. Bacterial overgrowth may be considered as evidence of the occurrence of nonsymptomatic environmental enteropathy in Terena Indian children.J Pediatr (Rio J) 2002; 78 (2): 113-9: nutritional status, lactose, lactulose, breath test, South American Indians, small intestine bacterial overgrowth. ResumoObjetivo: avaliar o estado nutricional, a absorção e a tolerância à lactose e a ocorrência de sobrecrescimento bacteriano no intestino delgado.Métodos: estudo transversal envolvendo todas as 264 crianças índias terenas, menores de 10 anos, das aldeias Limão Verde e Córrego Seco, em Aquidauana (MS). O estado nutricional foi avaliado pelo peso e pela estatura, relacionados com a referência do NCHS. Após a ingestão de 18 gramas de lactose, foi avaliada sua absorção, pelo teste do hidrogênio no ar expirado, e a tolerância de acordo com o aparecimento de manifestações clínicas. Sobrecrescimento bacteriano no intestino delgado foi avaliado com o teste do hidrogênio no ar expirado após a administração de lactulose (5g).Resultados: a mediana dos escores Z do peso-idade, pesoestatura e estatura-idade para as crianças com idade inferior a 12 meses (n=34) foram, respectivamente: -0,66, +0,60 e -0,85. Entre 1 e 5 anos (n=111) foram, respectivamente: -0,50, +0,28 e -1,17. Entre os 5 e 10 anos (n=119), estes valores foram, respectivamente: -0,09, +0,50 e -0,60. Após os 4 anos (n=197), absorção deficiente e má absorção de lactose foi observada em 89,3% das 197 crianças avaliadas. Intolerância à lactose foi observada em 37,1% destas 197 crianças. Sobrecrescimento bacteriano no intestino delgado foi caracterizado em...

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Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years of age

Mayo‐Wilson

Jean

Imdad

et al. 2014

Cochrane Database of Systematic Reviews

138

122

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BackgroundZinc deficiency is prevalent in low-and middle-income countries, and contributes to significant diarrhoea-, pneumonia-, and malariarelated morbidity and mortality among young children. Zinc deficiency also impairs growth. ObjectivesTo assess the effects of zinc supplementation for preventing mortality and morbidity, and for promoting growth, in children aged six months to 12 years of age.

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Tropical Enteropathy (Environmental Enteropathy) in Early Childhood: a Syndrome Caused by Contaminated Environment

Cited by 67 publications

References 0 publications

Chronic T Cell-Mediated Enteropathy in Rural West African Children: Relationship with Nutritional Status and Small Bowel Function

Chronic T Cell-Mediated Enteropathy in Rural West African Children: Relationship with Nutritional Status and Small Bowel Function

Nutritional status and breath hydrogen test with lactose and lactulose in Terena Indian children

Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years of age

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