title: Implications of acquired environmental enteric dysfunction for growth and stunting in infants and children living in low- and middle-income countries.
abstract: Changes in small bowel function early in infancy in developing countries are increasingly being demonstrated, probably accompanied by altered mucosal architecture in most individuals, including reduced enterocyte mass and evidence of immune activation and inflammation in the mucosa. These alterations appear to be the result of factors of uncertain nature in the environment, and may be a cause of growth faltering and stunting in young children. For these reasons, this constellation of findings is being referred to as environmental enteropathy, or as we propose herein, environmental enteric dysfunction. If the causes were known and effective interventions were available, strategies and policies to intervene at--or possibly before--birth could be developed and promoted in order to prevent subsequent malnutrition and recurrent infection, which are known to interact in a cyclical and synergistic manner in a downward clinical course often ending in death. Resources would be mobilized and applied differently, and the emphasis would change from treatment to prevention. In order to move in this highly desired direction, investments in research will be required to establish the criteria to assess environmental enteric dysfunction, determine its predictive value for growth faltering and stunting, identify the causes, and propose and test potential interventions. The concepts and tools are available. What is required is the decision to move forward along this pathway to better health for infants and children in low-income countries.
authors.affiliation: Boston University Medical Campus, 620 Albany Street, Boston MA 02118, USA. keusch@bu.edu
authors.forename: Gerald T
authors.initials: GT
authors.lastname: Keusch
authors.forename: Irwin H
authors.initials: IH
authors.lastname: Rosenberg
authors.forename: Donna M
authors.initials: DM
authors.lastname: Denno
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
authors.forename: James V
authors.initials: JV
authors.lastname: Lavery
authors.forename: Philip I
authors.initials: PI
authors.lastname: Tarr
authors.forename: Honorine D
authors.initials: HD
authors.lastname: Ward
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: James P
authors.initials: JP
authors.lastname: Nataro
authors.forename: Edward T
authors.initials: ET
authors.lastname: Ryan
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Hoosen
authors.initials: H
authors.lastname: Coovadia
authors.forename: Aldo
authors.initials: A
authors.lastname: Lima
authors.forename: Balakrishnan
authors.initials: B
authors.lastname: Ramakrishna
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
authors.forename: Deborah C Hay
authors.initials: DC
authors.lastname: Burgess
authors.forename: Thomas
authors.initials: T
authors.lastname: Brewer
mesh_terms: D015984:Causality; D003906:Developing Countries; D004781:Environmental Exposure; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000453:epidemiology*; D011203:Poverty