Environmental enteric dysfunction: a review of potential mechanisms, consequences and management strategies

Tickell, Kirkby D; Atlas, Hannah E; Walson, Judd L.

doi:10.1186/s12916-019-1417-3

Cited by 90 publications

(88 citation statements)

References 58 publications

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“…Similar WASH-related environmental risk factors for diarrhoea have been reported recently from Mozambique, Tanzania and Nepal [9,35,36]. Environmental enteric dysfunction is now considered the most important causes of stunting in children with diarrhoea in low-middle-income countries [4,37]. The lack of hand hygiene is a universal risk factor for diarrhoea [38].…”

Section: Discussionsupporting

confidence: 59%

Incidence and Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

Sharma

Mathur

Lundborg

et al. 2020

IJERPH

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Diarrhoea contributes significantly to the under-five childhood morbidity and mortality worldwide. This cross-sectional study was carried out in a tertiary care hospital in Ujjain, India from July 2015 to June 2016. Consecutive children aged 1 month to 12 years having “some dehydration” and “dehydration” according to World Health Organization classification were eligible to be included in the study. Other signs and symptoms used to assess severe dehydration were capillary refill time, urine output, and abnormal respiratory pattern. A questionnaire was administered to identify risk factors for severe dehydration, which was the primary outcome. Multivariate logistic regression modeling was used to detect independent risk factors for severe dehydration. The study included 332 children, with mean ± standard deviation age of 25.62 ± 31.85 months; out of which, 70% (95% confidence interval [CI] 65 to 75) were diagnosed to have severe dehydration. The independent risk factors for severe dehydration were: child not exclusive breastfed in the first six months of life (AOR 5.67, 95%CI 2.51 to 12.78; p < 0.001), history of not receiving oral rehydration solution before hospitalization (AOR 1.34, 95%CI 1.01 to 1.78; p = 0.038), history of not receiving oral zinc before hospitalization (AOR 2.66, 95%CI 1.68 to 4.21; p < 0.001) and living in overcrowded conditions (AOR 5.52, 95%CI 2.19 to 13.93; p < 0.001). The study identified many risk factors associated with severe childhood dehydration; many of them are modifiable though known and effective public health interventions.

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Section: Discussionsupporting

confidence: 59%

Incidence and Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

Sharma

Mathur

Lundborg

et al. 2020

IJERPH

View full text Add to dashboard Cite

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“…Similar WASH related environmental risk factors for diarrhoea have been reported recently from Mozambique, Tanzania and Nepal [35][36][37]. Environmental enteric dysfunction is now considered the most important causes of stunting in children with diarrhoea in low-middle-income countries [4,38]. The lack of hand hygiene is a universal risk factor for diarrhoea [39].…”

Section: Multivariate Analysissupporting

confidence: 59%

Incidence Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

Sharma¹,

Mathur²,

Lundborg³

et al. 2019

Preprint

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Diarrhoea contributes significantly in the under-five childhood morality and mortality worldwide. This cross-sectional study was carried out in a tertiary care hospital in Ujjain, India from July 2015 to June 2016. Consecutive children aged 1 month to 12 years having “some dehydration” and “dehydration” according to World Health Organization classification were eligible to be included in the study. Other signs and symptoms used to assess severe dehydration were capillary refill time, urine output, and abnormal respiratory pattern. A questionnaire was administered to identify risk factors for severe dehydration, which was the primary outcome. Multivariate logistic regression modeling was used to detect independent risk factors for severe dehydration. The study included 332 children, with mean ± standard deviation age of 25.62 ± 31.85 months; out of which, 70%(95% confidence interval [CI] 65 to 75) were diagnosed to have severe dehydration. The independent risk factors for severe dehydration were: child not exclusive breast fed in the first six months of life (AOR 5.67, 95%CI 2.51 to 12.78; p<0.001), history of not receiving oral rehydration solution before hospitalization (AOR 1.34, 95%CI 1.01 to 1.78; p=0.038), history of not receiving oral zinc before hospitalization (AOR 2.66, 95%CI 1.68 to 4.21; p<0.001) and living in overcrowded conditions (AOR 5.52, 95%CI 2.19 to 13.93; p<0.001). The study identified many risk factors associated with severe childhood dehydration; many of them are modifiable though known and effective public health interventions.

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Section: Discussionmentioning

confidence: 99%

“…In addition, human EED is a complex syndrome with multiple phenotypes depending on various adverse exposure 45 and geographic differences 46 and no single model captures the complexity of human EED 8 . Nevertheless, the present model provides valuable insights into key EED features to better understand mechanisms behind the human disease.…”

Section: Discussionmentioning

confidence: 99%

Modeling undernutrition with enteropathy in mice

Salameh

Jarbeau

Morel³

et al. 2020

Sci Rep

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Undernutrition is a global health issue leading to 1 out 5 all deaths in children under 5 years. Undernutrition is often associated with environmental enteric dysfunction (EED), a syndrome associated with increased intestinal permeability and gut inflammation. We aimed to develop a novel murine model of undernutrition with these EED features. Post-weaning mice were fed with low-protein diet (LP) alone or combined with a gastrointestinal insult trigger (indomethacin or liposaccharides). Growth, intestinal permeability and inflammation were assessed. LP diet induced stunting and wasting in post-weaning mice but did not impact gut barrier. We therefore combined LP diet with a single administration of indomethacin or liposaccharides (LPS). Indomethacin increased fecal calprotectin production while LPS did not. To amplify indomethacin effects, we investigated its repeated administration in addition to LP diet and mice exhibited stunting and wasting with intestinal hyperpermeability and gut inflammation. The combination of 3-weeks LP diet with repeated oral indomethacin administration induced wasting, stunting and gut barrier dysfunction as observed in undernourished children with EED. As noninvasive methods for investigating gut function in undernourished children are scarce, the present pre-clinical model provides an affordable tool to attempt to elucidate pathophysiological processes involved in EED and to identify novel therapeutic strategies.

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Environmental enteric dysfunction: a review of potential mechanisms, consequences and management strategies

Cited by 90 publications

References 58 publications

Incidence and Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

Incidence and Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

Incidence Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

Modeling undernutrition with enteropathy in mice

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