The impact of infection and nutrition on gut function and growth in childhood

Abstract

Poor growth performance during infancy and early childhood is a frequent fact of life in most developing countries. Work in The Gambia has demonstrated that more than 43 % of observed growth faltering during the first 15 months of life can be explained by the presence of a mucosal enteropathy in the small intestine. Within communities the illness is very common: in the area investigated more than 95 % of infants above 8 months of age were affected, and on average they suffered a growth-limiting enteropathy for more than 75 % of their first year of life. Two mechanisms of weight loss have been defined. First, partial villus atrophy reduces absorption and digestion of lactose and probably other nutrients. Second, and more importantly, damage to the mucosal barrier allows translocation of macromolecules into the mucosa and blood, triggering both local and systemic immune and inflammatory mechanisms. Given the severity of the enteropathy it is not surprising that infants fail to grow at a normal rate. Recent findings suggest that these lesions continue throughout childhood and into adulthood. Thus, a persistence of chronic, local and systemic inflammation throughout childhood may be responsible for continued poor growth during this period. Although the nature of the enteropathy and the mechanisms of growth failure have been defined, the factors involved in the initiation and persistence of the intestinal lesion remain uncertain, making clinical management difficult. More work is clearly required to elucidate these factors and to define interventions to prevent or treat the enteropathy.

Causal inference methods to study nonrandomized, preexisting development interventions

“…Poor nutrition is likely a key reason for this (30), but it remains possible that some faltering results from bacterial exposure that is insufficient to cause symptomatic diarrhea, but is sufficient to cause intestinal enteropathy in young children. Enteropathy is hypothesized to cause growth faltering through poor nutrient absorption and low-level immune system stimulation (29). Nutritionists have hypothesized that toilet provision and handwashing with soap could reduce enteropathy and improve growth (37).…”

“…Outcomes included sanitation, water and hygiene conditions and behavior, and health in children <5 y old measured by caregiver-reported diarrhea and anthropometric growth. Diarrhea and child weight measure acute illness in young children, whereas height measures cumulative effects of acute diarrheal illness and chronic intestinal enteropathy caused by repeated exposure to gastrointestinal pathogens (28)(29)(30).…”

Association of Helicobacter pylori Infection and Height of Mexican Children of Low Socioeconomic Level Attending Boarding Schools

“…28 Infection with H. pylori could produce a systemic immuno-stimulation and subsequent growth retardation. 29 Infections may also decrease appetite and increase the nutritional requirements because of a catabolic phase relationship with the immune response.…”

Life history theory and the immune system: Steps toward a human ecological immunology

“…Recent research indicates that diarrhea may cause damage to the intestinal mucosa that impairs nutrient absorption well beyond the point of recovery, potentially leading to a pernicious cycle of infection and malnutrition (Lunn, 2000;Lunn et al, 1991). In addition, a number of studies have documented reductions in food intake during infection, despite increased energetic demands Martorell et al, 1980;Mata et al, 1977).…”