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Ill Effects of Geophagia on Nutritional Status of Preschool Children
Published in Anil Gupta, Geophagia, 2019
Environmental enteropathy is a disorder of the intestinal mucosa and is characterized by its chronic inflammation. This disorder is prevalent in the child population residing in poor settings. According to Solomons (2003; Black et al. 2018), it is a leading cause of stunting among children in developing countries. It is manifested as low localized immunity of the gut and chronic inflammation. According to Humphrey (2009), environmental enteropathy is the second most important cause of growth deficits among children. The habit of geophagia predisposes children to environmental enteropathy and malnutrition. Solomons (2003) postulated uncertainty of the etiology of environmental enteropathy; nonetheless, it is associated with poor sanitation, unsafe drinking water, and unhygienic practices in daily life. These conditions predispose the fecal-oral route of infection (Wagner and Lanoix 1958). The authors described food, fluids, house flies, and fingers in the spread of infection in the fecal-oral route.
Impact of Different Exposures, Including Environmental Enteropathies, on Gut Flora and Integrity
Published in Crystal D. Karakochuk, Kyly C. Whitfield, Tim J. Green, Klaus Kraemer, The Biology of the First 1,000 Days, 2017
Environmental enteropathy is defined as a subclinical disorder resulting in structural and functional changes to the small intestine. The morphologic changes are proposed to occur through a T-cell mediated process characterized by a disruption in the balance between the proinflammatory (e.g., tumor necrosis factor alpha and interferon gamma) and regulatory cytokine-producing cells (e.g., transforming growth factor beta) [18]. The alterations include villous shortening and atrophy, crypt hyperplasia, and inflammatory cell infiltrate (e.g., lymphocytes and plasma cells) in the epithelium and lamina propria [16] (Figure 20.1). Gut function is consequently impaired. The damage to epithelial cells results in a loss of essential enzymes, and the decrease in the functional surface area of the intestinal epithelium causes maldigestion and malabsorption. An increase in gut permeability occurs due to the epithelial disruption leading to microbial translocation. This translocation into the systemic circulation consequently causes a state of chronic inflammation [16,19]. and altered intestinal resistance. The resulting in lowered immunity, increased susceptibility to infection, and loss of appetite, propagates the inflammation and malnutrition cycle (Figure 20.2) [20,21]. Continuous exposure to the enteric pathogens results in a state of perpetual hyperstimulation of the mucosal immune system. This is likely why oral vaccines, such as polio and rotavirus vaccines, are less effective in children with EED [22].
Water, Sanitation and Hygiene
Published in Bill Pritchard, Rodomiro Ortiz, Meera Shekar, Routledge Handbook of Food and Nutrition Security, 2016
Oliver Cumming, Louise Watson, Alan Dangour
A recent observational study in Bangladesh explicitly sought to test the hypothesis that children living in unsanitary environments, without improved WASH, were more likely to experience environmental enteropathy and to be stunted (Lin et al. 2013: 130–37). After adjusting for important confounding variables such as wealth and household head’s type of work, Lin and colleagues report that children categorized as living in ‘clean’, or sanitary, households had superior growth performance – they were on average 0.54 z-scores (95 per cent CI: 0.06, 1.01) taller than children living in ‘dirty’ households. Children in sanitary households also had better test results for important biological markers of EED – they had reduced total immunoglobulin G (IgG) levels (a measure of chronic immune-stimulation (Campbell et al. 2003: 1332–38)), and reduced lactulose:manitol ratios (a measure of gut function (Lunn et al. 1991: 907–10)) in their urine.
Mucosal and systemic immune responses to Vibrio cholerae infection and oral cholera vaccines (OCVs) in humans: a systematic review
Published in Expert Review of Clinical Immunology, 2022
Akshayata Naidu, Sajitha Lulu S
Other than preexisting immunity against a specific infection and co-infections, a condition called Environmental Enteropathy (EE) has also been doing rounds in scientific community and has been linked to the disruption of mucosal lining because of high burden of symptomatic and asymptomatic enteric infections [63]. A clear definition of this condition is still unknown, but it has been linked to lower absorbance of nutrition, stunt growth [63] and low vaccine efficacy [64] of oral vaccines in resource-limited settings. Although, it has been proposed that EE can directly negatively impact the immune responses elicited by the CVD-103, the live attenuated cholera vaccine, the cause of such a relation is much more intricate and complex than what would have been considered convenient for standard regression-based studies [65]. On the other hand, a recent study positively correlated biomarkers of EE with Dukoral® (WC-rBS) immune responses [66].
Challenges and opportunities for paediatric gastroenterology in low- and middle-income countries: high time for action
Published in Paediatrics and International Child Health, 2019
Stephen J. Allen, Akinlolu Adepojou, Olusegun O. Akinyinka
New insights into the role of environmental enteric dysfunction (EED, previously ‘tropical’ or ‘environmental’ enteropathy) in growth faltering present new opportunities. EED is a subclinical condition characterised in small intestinal biopsies by chronic inflammation, villous atrophy and a ‘leaky’ mucosa [18]. EED is universal where sanitation and hygiene are poor and occurs early in life despite exclusive breastfeeding; >80% of infants in an urban slum in Bangladesh had evidence of EED by 12 weeks of age in spite of exclusive breastfeeding for an average 120 days [19]. The main manifestation of EED is impaired linear and ponderal growth resulting from impaired nutrient digestion and absorption and increased systemic inflammation. Studies of growth faltering associated with enteropathy, diarrhoea and asymptomatic gut infections [20,21,22] have built on early work in The Gambia that attributed 40% of linear growth faltering to enteropathy [23].
Decreased performance of live attenuated, oral rotavirus vaccines in low-income settings: causes and contributing factors
Published in Expert Review of Vaccines, 2018
Daniel E. Velasquez, Umesh Parashar, Baoming Jiang
Environmental enteropathy (EE)—also referred as ‘environmental enteric dysfunction’—is a subclinical condition characterized by histological and functional abnormalities in the small intestine, which seem to be almost ubiquitous in children living in resource-poor settings [151]. A prospective longitudinal study of infants in an urban slum from Bangladesh showed that fecal alpha-1-antitrypsin and IL-10 (biomarkers of enteric and systemic inflammation, respectively) were significantly correlated with non-IgA seroconversion after RV1 vaccination (Table 8) [152]. In Nicaragua, the researchers found that two fecal biomarkers of EE: myeloperoxidase (MPO) and calprotectin (CAL) were statistically associated with diminished IgA seroconversion post RV5 [153]. The two studies have shown that EE biomarkers were associated with lower rotavirus vaccine immunogenicity.