title: New insights into environmental enteric dysfunction.
abstract: Environmental enteric dysfunction (EED) has been recognised as an important contributing factor to physical and cognitive stunting, poor response to oral vaccines, limited resilience to acute infections and ultimately global childhood mortality. The aetiology of EED remains poorly defined but the epidemiology suggests a multifactorial combination of prenatal and early-life undernutrition and repeated infectious and/or toxic environmental insults due to unsanitary and unhygienic environments. Previous attempts at medical interventions to ameliorate EED have been unsatisfying. However, a new generation of imaging and '-omics' technologies hold promise for developing a new understanding of the pathophysiology of EED. A series of trials designed to decrease EED and stunting are taking novel approaches, including improvements in sanitation, hygiene and nutritional interventions. Although many challenges remain in defeating EED, the global child health community must redouble their efforts to reduce EED in order to make substantive improvements in morbidity and mortality worldwide.
authors.affiliation: Department of Pediatrics, Washington University in St Louis, St Louis, Missouri, USA Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi.
authors.forename: Indi
authors.initials: I
authors.lastname: Trehan
authors.affiliation: Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK TROPGAN Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.affiliation: Department of Pediatrics, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Nurmohammad
authors.initials: N
authors.lastname: Shaikh
authors.affiliation: Department of Pediatrics, Washington University in St Louis, St Louis, Missouri, USA Department of Community Health, University of Malawi, Blantyre, Malawi Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D002648:Child; D004382:Duodenitis / Q000453:epidemiology* / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal; D004751:Enteritis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D004777:Environment; D000069196:Gastrointestinal Microbiome; D014943:Global Health; D006130:Growth Disorders / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D006304:Health Status; D006801:Humans; D007413:Intestinal Mucosa; D007579:Jejunal Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D018613:Microscopy, Confocal
keywords: Gastroenterology; Tropical Paediatrics; environmental enteric dysfunction; environmental enteropathy