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Environmental enteropathy and malnutrition: do we know enough to intervene?

Petri WA, Naylor C, Haque R - BMC Med (2014)

Bottom Line: It is implicated as a cause of stunting and malnutrition, oral vaccine failure and impaired development in children from low-income countries.The burden on child health of malnutrition alone, which affects 25% of all children and is estimated to result in more than a million deaths annually due to heightened susceptibility to infection, makes urgent a solution to EE.Efforts are thus underway to treat EE even while work continues to identify it through the use of non-invasive biomarkers, and delineate its pathogenesis.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA, 22908-1340, USA. wap3g@cms.mail.virginia.edu.

ABSTRACT
Environmental enteropathy (EE) is a poorly defined state of intestinal inflammation without overt diarrhea that occurs in individuals exposed over time to poor sanitation and hygiene. It is implicated as a cause of stunting and malnutrition, oral vaccine failure and impaired development in children from low-income countries. The burden on child health of malnutrition alone, which affects 25% of all children and is estimated to result in more than a million deaths annually due to heightened susceptibility to infection, makes urgent a solution to EE. Efforts are thus underway to treat EE even while work continues to identify it through the use of non-invasive biomarkers, and delineate its pathogenesis. A recent study published in BMC Medicine reports the first randomized controlled phase I trial of an anti-inflammatory drug for EE. The aminosalicylate mesalazine was found to be safe in short-term treatment of a small number of severely malnourished children, although efficacy was not established. Whether such treatment trials are premature, or instead a way both to understand and intervene in EE, is the focus of this article. Please see related article: http://www.biomedcentral.com/1741-7015/12/133.

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Related in: MedlinePlus

Frequency of enteropathogen detection in infants in Dhaka versus Virginia. Diarrheal and nondiarrheal stool samples were collected at the time points indicated and assayed for 29 enteropathogens by molecular methods. The total number of enteropathogens was summed for each sample; results are shown as mean ± SE. *Bonferroni adjusted P value <0.05 (determined with a linear mixed-effect regression model used to identify differences in the number of pathogens detected between diarrheal and surveillance samples for each month during the study period). **Nonparametric Wilcoxon 2-sample tests were used to compare numbers of pathogens between Virginia and Dhaka samples and between diarrheal and surveillance samples for Virginia alone [10]. SE, standard error.
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Fig2: Frequency of enteropathogen detection in infants in Dhaka versus Virginia. Diarrheal and nondiarrheal stool samples were collected at the time points indicated and assayed for 29 enteropathogens by molecular methods. The total number of enteropathogens was summed for each sample; results are shown as mean ± SE. *Bonferroni adjusted P value <0.05 (determined with a linear mixed-effect regression model used to identify differences in the number of pathogens detected between diarrheal and surveillance samples for each month during the study period). **Nonparametric Wilcoxon 2-sample tests were used to compare numbers of pathogens between Virginia and Dhaka samples and between diarrheal and surveillance samples for Virginia alone [10]. SE, standard error.

Mentions: Perhaps the most important finding was that mesalazine was safe in this small study of malnutrition treatment in infants. The safety of aminosalicylates, such as mesalazine, is attractive in the setting of treatment of already ill children who are suffering from SAM and multiple enteric infections [10]. The doses used were comparable to those used to induce remission for mild to moderate Crohn’s disease. This is a potentially important finding, as one could have anticipated a worsening of symptoms if inflammation was, in fact, protective via its action against enteropathogens in the gut (Figure 2). However, this conclusion may be premature, as treatment had no demonstrable effect on gut, and only a transient effect on systemic, inflammation.Figure 2


Environmental enteropathy and malnutrition: do we know enough to intervene?

Petri WA, Naylor C, Haque R - BMC Med (2014)

Frequency of enteropathogen detection in infants in Dhaka versus Virginia. Diarrheal and nondiarrheal stool samples were collected at the time points indicated and assayed for 29 enteropathogens by molecular methods. The total number of enteropathogens was summed for each sample; results are shown as mean ± SE. *Bonferroni adjusted P value <0.05 (determined with a linear mixed-effect regression model used to identify differences in the number of pathogens detected between diarrheal and surveillance samples for each month during the study period). **Nonparametric Wilcoxon 2-sample tests were used to compare numbers of pathogens between Virginia and Dhaka samples and between diarrheal and surveillance samples for Virginia alone [10]. SE, standard error.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197320&req=5

Fig2: Frequency of enteropathogen detection in infants in Dhaka versus Virginia. Diarrheal and nondiarrheal stool samples were collected at the time points indicated and assayed for 29 enteropathogens by molecular methods. The total number of enteropathogens was summed for each sample; results are shown as mean ± SE. *Bonferroni adjusted P value <0.05 (determined with a linear mixed-effect regression model used to identify differences in the number of pathogens detected between diarrheal and surveillance samples for each month during the study period). **Nonparametric Wilcoxon 2-sample tests were used to compare numbers of pathogens between Virginia and Dhaka samples and between diarrheal and surveillance samples for Virginia alone [10]. SE, standard error.
Mentions: Perhaps the most important finding was that mesalazine was safe in this small study of malnutrition treatment in infants. The safety of aminosalicylates, such as mesalazine, is attractive in the setting of treatment of already ill children who are suffering from SAM and multiple enteric infections [10]. The doses used were comparable to those used to induce remission for mild to moderate Crohn’s disease. This is a potentially important finding, as one could have anticipated a worsening of symptoms if inflammation was, in fact, protective via its action against enteropathogens in the gut (Figure 2). However, this conclusion may be premature, as treatment had no demonstrable effect on gut, and only a transient effect on systemic, inflammation.Figure 2

Bottom Line: It is implicated as a cause of stunting and malnutrition, oral vaccine failure and impaired development in children from low-income countries.The burden on child health of malnutrition alone, which affects 25% of all children and is estimated to result in more than a million deaths annually due to heightened susceptibility to infection, makes urgent a solution to EE.Efforts are thus underway to treat EE even while work continues to identify it through the use of non-invasive biomarkers, and delineate its pathogenesis.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA, 22908-1340, USA. wap3g@cms.mail.virginia.edu.

ABSTRACT
Environmental enteropathy (EE) is a poorly defined state of intestinal inflammation without overt diarrhea that occurs in individuals exposed over time to poor sanitation and hygiene. It is implicated as a cause of stunting and malnutrition, oral vaccine failure and impaired development in children from low-income countries. The burden on child health of malnutrition alone, which affects 25% of all children and is estimated to result in more than a million deaths annually due to heightened susceptibility to infection, makes urgent a solution to EE. Efforts are thus underway to treat EE even while work continues to identify it through the use of non-invasive biomarkers, and delineate its pathogenesis. A recent study published in BMC Medicine reports the first randomized controlled phase I trial of an anti-inflammatory drug for EE. The aminosalicylate mesalazine was found to be safe in short-term treatment of a small number of severely malnourished children, although efficacy was not established. Whether such treatment trials are premature, or instead a way both to understand and intervene in EE, is the focus of this article. Please see related article: http://www.biomedcentral.com/1741-7015/12/133.

Show MeSH
Related in: MedlinePlus