Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh.
There is a growing body of literature indicating an association between stunting and environmental enteropathy (EE), a disorder thought to be caused by repeated exposures to enteric pathogens. To investigate the relationship between exposure to enteric pathogens through geophagy, consumption of soil, EE, and stunting, we conducted a prospective cohort study of 216 children under 5 years of age in rural Bangladesh. Geophagy was assessed at baseline using 5 hour structured observation and caregiver reports. Stool was analyzed for fecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin (all three combined to form an EE disease activity score), and calprotectin. Eighteen percent of children had observed geophagy events by structured observation and 28% had caregiver reported events in the past week. Nearly all households had Escherichia coli (97%) in soil, and 14% had diarrheagenic E. coli. Children with caregiver-reported geophagy had significantly higher EE scores (0.72 point difference, 95% confidence interval [CI]: 0.01, 1.42) and calprotectin concentrations (237.38 μg/g, 95% CI: 12.77, 462.00). Furthermore, at the 9-month follow-up the odds of being stunted (height-for-age z-score < -2) was double for children with caregiver-reported geophagy (odds ratio [OR]: 2.27, 95% CI: 1.14, 4.51). These findings suggest that geophagy in young children may be an important unrecognized risk factor for EE and stunting.
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh cmgeorge@jhsph.edu.
Christine Marie
CM
George
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Lauren
L
Oldja
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Shwapon
S
Biswas
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Jamie
J
Perin
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Gwenyth O
GO
Lee
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Margaret
M
Kosek
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
R Bradley
RB
Sack
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Shahnawaz
S
Ahmed
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Rashidul
R
Haque
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Tahmina
T
Parvin
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Ishrat J
IJ
Azmi
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Sazzadul Islam
SI
Bhuyian
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Kaisar A
KA
Talukder
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Shahnaij
S
Mohammad
Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Abu G
AG
Faruque
D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D004926:Escherichia coli; D005243:Feces / Q000382:microbiology; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000150:complications / Q000209:etiology*; D008297:Male; D010842:Pica / Q000150:complications*; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D012987:Soil; D012988:Soil Microbiology
D012987:Soil