The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease

Abstract

More than one-fifth of the world’s population live in extreme poverty, where a lack of safe water and adequate sanitation enables high rates of enteric infections and diarrhoea to continue unabated. Although oral rehydration therapy has greatly reduced diarrhoea-associated mortality, enteric infections still persist, disrupting intestinal absorptive and barrier functions and resulting in up to 43% of stunted growth, affecting one-fifth of children worldwide and one-third of children in developing countries. Diarrhoea in children from impoverished areas during their first 2 years might cause, on average, an 8 cm growth shortfall and 10 IQ point decrement by the time they are 7–9 years old. A child’s height at their second birthday is therefore the best predictor of cognitive development or ‘human capital’. To this ‘double burden’ of diarrhoea and malnutrition, data now suggest that children with stunted growth and repeated gut infections are also at increased risk of developing obesity and its associated comorbidities, resulting in a ‘triple burden’ of the impoverished gut. Here, we Review the growing evidence for this triple burden and potential mechanisms and interventions that must be understood and applied to prevent the loss of human potential and unaffordable societal costs caused by these vicious cycles of poverty.

Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape

“…72 Evidence continues to mount that enteric infections and enteric or systemic inflammation in early childhood or prenatally can impair growth and development and perhaps even increase later life associations with obesity, metabolic syndrome or cardiovascular disease. 22,32,73 Murine models also confirm that infection can impair growth and undernutrition can greatly worsen infection burdens and their growth impairment, documenting a potential "vicious cycle" with such enteric pathogens as cryptosporidium or enteroaggregative Escherichia coli. 74,75 Although stunting may be an increasingly imperfect surrogate for the long-term effects of early life enteric infections, Victora et al 43 have noted that the height-for-age z score around the second birthday can be the best predictor of "human capital" in terms of educational attainment, economic productivity, and even the weight of future offspring.…”

“…Examples that provoke challenging genetic, epigenetic, microbiologic, and metabolomic models for understanding include potential development and metabolic consequences of diseases of poverty, such as repeated enteric infections in early childhood in impoverished areas. 22 The associations of key prenatal factors and being small for gestational age (SGA) with an increased risk of mortality 23 …”

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

“…EED is associated with a number of undesirable developmental outcomes, including poor response to vaccines and increased susceptibility to infection 8 , and most strongly with impaired growth velocity and stunting 9,10 . It is now thought that EED is an important component of the link between poor environmental conditions and reduced height, and a cause of the limited success of nutritional interventions in overcoming this growth deficit in many populations 11 .…”

Perbedaan Asupan Energi, Protein, Zink, dan Perkembangan pada Balita Stunting dan non Stunting

“…Jika suatu keluarga mengalami kemiskinan, maka dapat meningkatkan risiko terjadinya diare yang terus berkelanjutan karena kekurangan air bersih dan sanitasi. Diare akan mengganggu fungsi penyerapan didalam usus sehingga dapat mengakibatan balita mengalami pertumbuhan yang terhambat 17 . Tabel 1 menunjukkan bahwa asupan energi pada balita stunting sebagian besar termasuk kategori kurang yaitu 22 balita (68,8%) sedangkan pada balita non stunting paling besar termasuk kategori cukup yaitu 23 balita (71,9%).…”