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Related Experiment Video

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Environmental enteric dysfunction pathways and child stunting: A systematic review.

Kaitlyn M Harper1, Maxine Mutasa2, Andrew J Prendergast3,4,5

  • 1School of Population and Public Health, University of British Columbia, Vancouver, Canada.

Plos Neglected Tropical Diseases
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Environmental enteric dysfunction (EED) biomarkers show weak links to stunting, suggesting some measures need reevaluation. Further research into pathogen-induced gut changes is recommended for understanding child stunting.

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Area of Science:

  • Pediatric Health
  • Gastroenterology
  • Nutritional Science

Background:

  • Environmental enteric dysfunction (EED) is an acquired small intestine disorder linked to childhood stunting in developing nations.
  • EED is characterized by villous atrophy and crypt hyperplasia, with various biomarkers used to assess its domains.
  • The study investigates the data-supported relationships among EED domains and between EED and stunting.

Purpose of the Study:

  • To evaluate the evidence supporting hypothesized relationships among EED biomarker domains.
  • To assess the data-backed connections between EED domains and childhood stunting.
  • To identify potential limitations in current EED biomarkers.

Main Methods:

  • A systematic literature search was performed across major databases (PubMed, MEDLINE, EMBASE, Web of Science, CINAHL) from 2010 to 2017.
  • Data on study objectives, design, population, location, biomarkers, and results were extracted and analyzed.
  • Biomarkers were categorized into five EED domains to summarize supporting and refuting evidence for hypothesized pathways.

Main Results:

  • Limited evidence supports pathways from intestinal permeability to microbial translocation and from microbial translocation to stunting.
  • Stronger evidence links intestinal inflammation to systemic inflammation and to stunting.
  • Conflicting evidence exists for pathways involving intestinal damage, intestinal permeability, and stunting.

Conclusions:

  • Certain EED biomarkers, especially intestinal permeability and microbial translocation, may require reconsideration due to measurement challenges and weak evidential support.
  • Current EED biomarker utility is discussed, highlighting issues with existing measures.
  • Further investigation into pathogen-induced alterations of the intestinal microbiota is recommended as a potential pathway to stunting.