Biomarkers of Environmental Enteric Dysfunction Among Children in Rural Bangladesh

Rebecca K. Campbell, Kerry Schulze, Saijuddin Shaikh, Sucheta Mehra, Hasmot Ali, Lee Wu, Rubhana Raqib, Sarah Baker, Alain Labrique, Keith P. West, Parul Christian

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Abstract

OBJECTIVES:: Environmental enteric dysfunction (EED) may inhibit growth and development in low- and middle-income countries, but available assessment methodologies limit its study. In rural Bangladesh, we measured EED using the widely-used lactulose mannitol ratio (L:M) test and a panel of intestinal and systemic health biomarkers to evaluate convergence among biomarkers and describe risk factors for EED. METHODS:: In 539 18-month-old children finishing participation in a randomized food supplementation trial, serum, stool and urine collected after lactulose and mannitol dosing were analyzed for biomarkers of intestinal absorption, inflammation, permeability and repair, and systemic inflammation. EED scores for each participant were developed using principal component analysis (PCA) and partial least squares regression (PLS). Associations between scores and L:M and with child sociodemographic and health characteristics were evaluated using regression analysis. RESULTS:: EED prevalence (L:M>0.07) was 39.0%; 60% had elevated acute phase proteins (CRP>5?mg/L or AGP>100?mg/dL). Correlations between intestinal biomarkers were low, with the highest between myeloperoxidase and α-1 antitrypsin (r?=?0.33, p?<?0.01), and biomarker values did not differ by supplementation history. A one-factor PLS model with L:M as the dependent variable explained only 8.6% of L:M variability. In adjusted models, L:M was associated with child sex and SES index, while systemic inflammation was predicted mainly by recent illness, not EED. CONCLUSIONS:: Impaired intestinal health is widespread in this setting of prevalent stunting, but a panel of serum and stool biomarkers demonstrated poor agreement with L:M. Etiologies of intestinal and systemic inflammation are likely numerous and complex in resource-poor settings, underscoring the need for a better case definition with corresponding diagnostic methods to further the study of EED.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

Original languageEnglish (US)
JournalJournal of Pediatric Gastroenterology and Nutrition
DOIs
StateAccepted/In press - Mar 8 2017

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

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