ArticleNature microbiology2021
Adaptation of the small intestine to microbial enteropathogens in Zambian children with stunting.
Article in Nature microbiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 35 papers.
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Who cites it
35 citing papers in PubMed, 56 citations in OpenAlex.
- Daily Complementary Feeding With Eggs Improves Fibroblast Growth Factor 21 in Infants.Maternal & child nutrition · 2025Trial
- Stunting Status and Exposure to Infection and Inflammation in Early Life Shape Antibacterial Immune Cell Function Among Zimbabwean Children.Frontiers in immunology · 2022Trial
- Elevated Levels of Environmental Enteric Dysfunction Biomarkers Among Rural Indonesian Infants: Associations with Water, Sanitation, Hygiene and Linear Growth.Tropical medicine and infectious disease · 2026Article
- Structural and Hormonal Changes Associated With Starvation in Zambian Adult Patients With Esophageal Strictures: A Cross-Sectional Study.Health science reports · 2026Article
- Plasma lipopolysaccharide levels predict mortality in acutely ill children in Low- and Middle-Income Countries.Nature communications · 2025Article
- Is there dietary macronutrient malabsorption in children with environmental enteropathy?European journal of clinical nutrition · 2025Review
- Association of environmental enteropathy with prediabetes and diabetes: A cross-sectional study among Tanzanian adults.PloS one · 2025Article
- Intestine bacterial community affects the growth of the Pacific white shrimp (Litopenaeus vannamei).Applied microbiology and biotechnology · 2024Article
- The Environmental Enteric Dysfunction Biopsy Initiative (EEDBI) Consortium: mucosal investigations of environmental enteric dysfunction.The American journal of clinical nutrition · 2024Article
- Duodenal transcriptomics demonstrates signatures of tissue inflammation and immune cell infiltration in children with environmental enteric dysfunction across global centers.The American journal of clinical nutrition · 2024Article
- Biomarker relationships with small bowel histopathology among malnourished children with environmental enteric dysfunction in a multicountry cohort study.The American journal of clinical nutrition · 2024Article
- Histopathology underlying environmental enteric dysfunction in a cohort study of undernourished children in Bangladesh, Pakistan, and Zambia compared with United States children.The American journal of clinical nutrition · 2024Article
- Article
- NADScience translational medicine · 2024Article
- Novel gastrointestinal tools (GI Tools) for evaluating gut functional capacity in adults with environmental enteropathy in Zambia and Zimbabwe: A cross-sectional study protocol.F1000Research · 2024Article
- Inflammation: the driver of poor outcomes among children with severe acute malnutrition?Nutrition reviews · 2023Review
- Severe acute malnutrition promotes bacterial binding over proinflammatory cytokine secretion by circulating innate immune cells.Science advances · 2023Article
- Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia.European journal of clinical nutrition · 2023Observational
- The intersection of undernutrition, microbiome, and child development in the first years of life.Nature communications · 2023Review
- Intestinal Epithelial Digestive, Transport, and Barrier Protein Expression Is Increased in Environmental Enteric Dysfunction.Laboratory investigation; a journal of technical methods and pathology · 2023Article
Corrections and comments
- Erratum issued
Authors and funding
14 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Environmental enteropathy is a major contributor to growth faltering in millions of children in Africa and South Asia. We carried out a longitudinal, observational and interventional study in Lusaka, Zambia, of 297 children with stunting (aged 2-17 months at recruitment) and 46 control children who had good growth (aged 1-5 months at recruitment). Control children contributed data only at baseline. Children were provided with nutritional supplementation of daily cornmeal-soy blend, an egg and a micronutrient sprinkle, and were followed up to 24 months of age. Children whose growth did not improve over 4-6 months of nutritional supplementation were classified as having non-responsive stunting. We monitored microbial translocation from the gut lumen to the bloodstream in the cohort with non-responsive stunting (n = 108) by measuring circulating lipopolysaccharide (LPS), LPS-binding protein and soluble CD14 at baseline and when non-response was declared. We found that microbial translocation decreased with increasing age, such that LPS declined in 81 (75%) of 108 children with non-responsive stunting, despite sustained pathogen pressure and ongoing intestinal epithelial damage. We used confocal laser endomicroscopy and found that mucosal leakiness also declined with age. However, expression of brush border enzyme, nutrient transporter and mucosal barrier genes in intestinal biopsies did not change with age or correlate with biomarkers of microbial translocation. We propose that environmental enteropathy arises through adaptation to pathogen-mediated epithelial damage. Although environmental enteropathy reduces microbial translocation, it does so at the cost of impaired growth. The reduced epithelial surface area imposed by villus blunting may explain these findings.
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