Environmental enteropathy is associated with cardiometabolic risk factors in Peruvian children

Lee, Gwenyth O.; Olortegui, MP; Salas, Mery Siguas; Yori, Pablo Peñataro; Trigoso, Dixner Rengifo; Kosek, Peter; Mispireta, Monica; Oberhelman, Richard A.; Caulfield, Laura E.; Kosek, Margaret

doi:10.1017/s2040174417000071

Cited by 16 publications

(31 citation statements)

References 65 publications

(99 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No association between microbial translocation and permeability/absorption was observed in 2 studies [ 55 , 63 ], and 1 study observed conflicting results between the two domains [ 120 ]. Two studies did not report direct associations between permeability/absorption and microbial translocation [ 33 , 107 ].…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, 4 studies found no association between microbial translocation and linear growth [ 55 , 99 , 107 , 122 ], and one study reported an unexpected positive association between microbial translocation and linear growth [ 63 ]. One study observed conflicting results between microbial translocation and linear growth [ 123 ], and 3 studies did not report associations [ 33 , 53 , 105 ].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies observed associations of microbial translocation with markers of systemic inflammation [ 63 , 120 ], while another study found no association [ 53 ]. The remaining 3 studies did not report associations between microbial translocation and inflammation [ 33 , 105 , 121 ]. In summary, the pathway between microbial translocation and linear growth was not well supported, and there was inconsistent support for the pathways between microbial translocation and other domains.…”

Section: Resultsmentioning

confidence: 99%

“…The L:M test has been measured in numerous populations, but procedural details (fasting prior to ingestion, sugar dosage, time of urine collection, assay method) vary, which hinders comparisons between studies; moreover, reference cut-points for the diagnosis of children with EED using the sugar absorption test have not been established [ 50 ]. Twelve studies used L:M ratio cut-points of 0.06–0.07 [ 33 , 63 , 101 , 115 , 117 , 125 ] or 0.10–0.15 [ 55 , 108 , 111 , 112 , 103 , 126 ] to define EED. Three studies categorized EED as moderate or severe, where L:M values of 0.28–0.45 were used for severe cases [ 101 , 104 , 112 ].…”

Section: Discussionmentioning

confidence: 99%

“…To review the evidence supporting the complex mechanisms that may contribute to child stunting we have elected to organize results according to these five EED domains: (1) intestinal damage and repair, (2) permeability and absorption, (3) microbial translocation, (4) intestinal inflammation, and (5) systemic inflammation. These domains were determined by consensus from reviewing previous conceptual frameworks and descriptions [ 2 , 3 , 23 , 24 , 29 , 33 – 41 ]. Each domain and its respective non-invasive biomarkers are described below.…”

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

Environmental enteric dysfunction pathways and child stunting: A systematic review

et al. 2018

View full text Add to dashboard Cite

BackgroundEnvironmental enteric dysfunction (EED) is commonly defined as an acquired subclinical disorder of the small intestine, characterized by villous atrophy and crypt hyperplasia. EED has been proposed to underlie stunted growth among children in developing countries. A collection of biomarkers, organized into distinct domains, has been used to measure different aspects of EED. Here, we examine whether these hypothesized relationships, among EED domains and between each domain and stunting, are supported by data from recent studies.MethodologyA systematic literature search was conducted using PubMed, MEDLINE, EMBASE, Web of Science, and CINAHL between January 1, 2010 and April 20, 2017. Information on study objective, design, population, location, biomarkers, and results were recorded, as well as qualitative and quantitative definitions of EED. Biomarkers were organized into five EED domains, and the number of studies that support or do not support relationships among domains and between each domain with stunting were summarized.ResultsThere was little evidence to support the pathway from intestinal permeability to microbial translocation and from microbial translocation to stunting, but stronger support existed for the link between intestinal inflammation and systemic inflammation and for intestinal inflammation and stunting. There was conflicting evidence for the pathways from intestinal damage to intestinal permeability and intestinal damage to stunting.ConclusionsThese results suggest that certain EED biomarkers may require reconsideration, particularly those most difficult to measure, such as microbial translocation and intestinal permeability. We discuss several issues with currently used biomarkers and recommend further analysis of pathogen-induced changes to the intestinal microbiota as a pathway leading to stunting.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Environmental enteric dysfunction pathways and child stunting: A systematic review

et al. 2018

View full text Add to dashboard Cite

show abstract

Disentangling Microbial Mediators of Malnutrition: Modeling Environmental Enteric Dysfunction

Bartelt

Bolick

2019

Cellular and Molecular Gastroenterology and Hepatology

View full text Add to dashboard Cite

Environmental enteric dysfunction (EED) (also referred to as environmental enteropathy) is a subclinical chronic intestinal disorder that is an emerging contributor to early childhood malnutrition. EED is common in resource-limited settings, and is postulated to consist of small intestinal injury, dysfunctional nutrient absorption, and chronic inflammation that results in impaired early child growth attainment. Although there is emerging interest in the hypothetical potential for chemical toxins in the environmental exposome to contribute to EED, the propensity of published data, and hence the focus of this review, implicates a critical role of environmental microbes. Early childhood malnutrition and EED are most prevalent in resource-limited settings where food is limited, and inadequate access to clean water and sanitation results in frequent gastrointestinal pathogen exposures. Even as overt diarrhea rates in these settings decline, silent enteric infections and faltering growth persist. Furthermore, beyond restricted physical growth, EED and/or enteric pathogens also associate with impaired oral vaccine responses, impaired cognitive development, and may even accelerate metabolic syndrome and its cardiovascular consequences. As these potentially costly long-term consequences of early childhood enteric infections increasingly are appreciated, novel therapeutic strategies that reverse damage resulting from nutritional deficiencies and microbial insults in the developing small intestine are needed. Given the inherent limitations in investigating how specific intestinal pathogens directly injure the small intestine in children, animal models provide an affordable and controlled opportunity to elucidate causal sequelae of specific enteric infections, to differentiate consequences of defined nutrient deprivation alone from co-incident enteropathogen insults, and to correlate the resulting gut pathologies with their functional impact during vulnerable early life windows.

show abstract

Nutrient intakes from complementary foods are associated with cardiometabolic biomarkers among undernourished Peruvian children

et al. 2023

Self Cite

View full text Add to dashboard Cite

Relatively little is known about how the diet of chronically undernourished children may impact cardiometabolic biomarkers. The objective of this exploratory study was to characterise relationships between dietary patterns and the cardiometabolic profile of 153 3–5-year-old Peruvian children with a high prevalence of chronic undernutrition. We collected monthly dietary recalls from children when they were 9–24 months old. At 3–5 years, additional dietary recalls were collected, and blood pressure, height, weight, subscapular skinfolds and fasting plasma glucose, insulin and lipid profiles were assessed. Nutrient intakes were expressed as average density per 100 kcals (i) from 9 to 24 months and (ii) at follow-up. The treelet transform and sparse reduced rank regress'ion (RRR) were used to summarize nutrient intake data. Linear regression models were then used to compare these factors to cardiometabolic outcomes and anthropometry. Linear regression models adjusting for subscapular skinfold-for-age Z-scores (SSFZ) were then used to test whether observed relationships were mediated by body composition. 26 % of children were stunted at 3–5 years old. Both treelet transform and sparse RRR-derived child dietary factors are related to protein intake and associated with total cholesterol and SSFZ. Associations between dietary factors and insulin were attenuated after adjusting for SSFZ, suggesting that body composition mediated these relationships. Dietary factors in early childhood, influenced by protein intake, are associated with cholesterol profiles, fasting glucose and body fat in a chronically undernourished population.

show abstract

Environmental enteropathy is associated with cardiometabolic risk factors in Peruvian children

Cited by 16 publications

References 65 publications

Environmental enteric dysfunction pathways and child stunting: A systematic review

Environmental enteric dysfunction pathways and child stunting: A systematic review

Disentangling Microbial Mediators of Malnutrition: Modeling Environmental Enteric Dysfunction

Nutrient intakes from complementary foods are associated with cardiometabolic biomarkers among undernourished Peruvian children

Contact Info

Product

Resources

About