Assessment of Environmental Enteric Dysfunction in Infants in Mirpur, Dhaka, Bangladessh

Abstract

Around 25 percent of the world's children aged < 5 have stunted growth, which is associated with increased mortality, cognitive dysfunction and productivity loss. Reducing the number of stunted children by 40 per cent is a global aim for 2030. An approximate 1 in 4 (23 per cent) children aged <5 years have been stunted worldwide in 2017. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not solely due to insufficient diet or diarrhea, it remains that other factors have to explain the continued faltering growth. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and (EED) is an acquired enteropathy of the small intestine, characterized by enteric inflammation, villus blunting and decreased crypt-to-villus ratio. EED has been associated with poor outcomes, including chronic malnutrition (stunting), wasting and reduced vaccine efficacy among children living in low-resource settings. EED is proposed as an immediate causal factor connecting poor sanitation and stunting. Recurring exposure to fecal pathogens and changes in the composition of the intestinal microbiota are hypothesized to initiate this process which leads to a self-perpetuating cycle of pathology. We see EED as a primary gut disorder that drives chronic systemic inflammation, resulting in resistance to growth hormones and impaired linear growth. Mechanisms which contribute to EED growth failure include intestinal leakage and increased permeability, inflammation of the gut, dysbiosis and translocation of bacteria, systemic inflammation and malabsorption of nutrients; There is currently no agreed case description or EED gold standard biomarker, which challenges field studies. My goals are to define the evolution of EED during infancy, determine its contribution to stunting, identify associations between EED and biomarkers and also assess the relationship between EED and prospective linear Development at 52 weeks of infants.