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Review
. 2016 Aug:10:25-32.
doi: 10.1016/j.ebiom.2016年07月03日0. Epub 2016 Jul 26.

Environmental Enteropathy: Elusive but Significant Subclinical Abnormalities in Developing Countries

Affiliations
Review

Environmental Enteropathy: Elusive but Significant Subclinical Abnormalities in Developing Countries

Koji Watanabe et al. EBioMedicine. 2016 Aug.

Abstract

Environmental enteropathy/Environmental enteric dysfunction (EE/EED) is a chronic disease of small intestine characterized by gut inflammation and barrier disruption, malabsorption and systemic inflammation in the absence of diarrhea. It is predominantly diseases of children in low income countries and is hypothesized to be caused by continuous exposure to fecally contaminated food, water and fomites. It had not been recognized as a priority health issue because it does not cause overt symptoms and was seen in apparently healthy individuals. However, there is a growing concern of EE/EED because of its impact on longitudinal public health issues, such as growth faltering, oral vaccine low efficacy and poor neurocognitive development. Recent works have provided important clues to unravel its complex pathogenesis, and suggest possible strategies for controlling EE/EED. However, effective diagnostic methods and interventions remain unsettled. Here, we review the existing literature, especially about its pathogenesis, and discuss a solution for children living in the developing world.

Keywords: Environmental enteric dysfunction; Environmental enteropathy; Growth faltering; Neurocognitive development; Oral vaccine.

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Figures

Fig. 1
Fig. 1
Pathogenesis of EE/EED and long-lasting consequences. Continuous exposure to feces triggers EE/EED in individuals living in poor sanitary condition. Pathogenic conditions are seen systemically as well as locally in small intestine (black arrows). Pathogenic conditions have adverse effects on children's health as inducing long-lasting consequences (red arrows). These consequences, in turn, contribute a vicious cycle (blue arrows). Abbreviations, EE, environmental enteropathy; EED, environmental enteric dysfunction; SIBO, small intestine bacterial overgrowth.
Fig. 2
Fig. 2
Cluster dendrogram of biomarkers of EE/EED. This hierarchical analysis of biomarkers can accommodate a mixture of quantitative and qualitative variables and classify those strongly correlated or similar biomarkers into the same clusters using homogeneity criterion. Adjacent markers are the most closely correlated, while increased distance indicates decreasing correlations. Biological samples (blood or urine) were collected at 6, 12 and/or 18 weeks of age in the PROVIDE study. Cytokines were collected at 18 weeks of age, and analyzed as the association of 50–75th percentile as (2), and 75–100th percentile as (3). Biomarkers were well differentiated by the 3 major clusters, consisting cluster 1 (systemic inflammation in red), cluster 2 (enteric inflammation and malabsorption in black) and cluster 3 (maternal health in green). Adapted from the paper by Naylor et al. (Naylor et al., 2015). Abbreviations, IL, interleukin; TNF, Tissue necrosis factor; MIP, macrophage inflammatory protein; CRP, C-reactive protein; sCD, soluble cluster of differentiation; MPO, myeloperoxidase; Reg, regenerating islet derived protein; RBP, retinol binding protein; HAZ, height-for-age Z-score; WAZ, weight-for-age Z-score; WHZ, weight-for-height Z score.

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