Prevalence and Correlates of Environmental Enteric Dysfunction Among Young Children in Bangladesh

Bangladesh continues to experience high levels of child undernutrition, with stunting affecting approximately 24% of children under 5 years of age. Environmental enteric dysfunction (EED), a subclinical intestinal disorder characterized by chronic inflammation, immune activation, and nutrient malabsorption, may reduce the effectiveness of nutritional interventions. Identifying factors that may enhance resilience to EED could guide intervention design. This study measured two biomarkers of EED, fecal calprotectin (CAL) and myeloperoxidase (MPO), among 160 Bangladeshi children 9-11 months of age and assessed associations between these biomarkers and indicators of child growth, micronutrient status, and inflammation using multivariate logistic regression. Outcomes were defined as CAL, MPO, or both biomarkers below the 25th percentile. CAL (> 160 µg/g) and MPO (> 2000 ng/mL) were elevated in over 90% and 70% of children, respectively, indicating widespread intestinal inflammation. In multivariable models, higher mid-upper arm circumference-for-age Z-scores (MUAC-Z) were associated with lower CAL (OR 1.51, 95% CI 1.04-2.18) and combined low CAL and MPO values (OR 1.72, 95% CI 1.06-2.81). Higher retinol-binding protein (RBP) was strongly associated with lower MPO (OR 4.91, 95% CI 1.28-18.83), while lower α-1-acid glycoprotein (AGP) levels were associated with lower MPO values (OR 0.53, 95% CI 0.27-1.04). Better ponderal growth, adequate vitamin A status, and lower systemic inflammation characterized children with lower concentrations of EED biomarkers. Reducing the burden of EED may help to enhance the effectiveness of nutrition interventions.