ArticleThe American journal of clinical nutrition2024
Histopathology underlying environmental enteric dysfunction in a cohort study of undernourished children in Bangladesh, Pakistan, and Zambia compared with United States children.
Article in The American journal of clinical nutrition, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- 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
- Environmental enteric dysfunction in well-nourished and undernourished women in Bangladesh.BMC gastroenterology · 2026Article
- Maternal undernutrition exacerbates microbiota-driven growth stunting through pre- and postnatal effects.Cell reports · 2025Article
- Association of Intestinal Amino Acid Absorption with the Uptake of Lactulose and Rhamnose in Adults with Environmental Enteropathy.The American journal of tropical medicine and hygiene · 2025Article
- Host-microbiome determinants of ready-to-use supplemental food efficacy in acute childhood malnutrition.JCI insight · 2025Article
- Mild Duodenal Mucosal Injury and Increased Type I Interferon Signaling Are Preludes to Celiac Disease.Laboratory investigation; a journal of technical methods and pathology · 2025Article
- Review
- Multiplexed immunohistochemical evaluation of small bowel inflammatory and epithelial parameters in environmental enteric dysfunction.The American journal of clinical nutrition · 2024Article
- The Environmental Enteric Dysfunction Biopsy Initiative (EEDBI) Consortium: mucosal investigations of environmental enteric dysfunction.The American journal of clinical nutrition · 2024Article
- Anthropometry relationship with duodenal histologic features of children with environmental enteric dysfunction: a multicenter cross-sectional study.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
- Duodenal quantitative mucosal morphometry in children with environmental enteric dysfunction: a cross-sectional multicountry analysis.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
- Enteric pathogens relationship with small bowel histologic features of environmental enteric dysfunction in a multicountry cohort study.The American journal of clinical nutrition · 2024Article
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24 authors.
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Abstract
backgroundEnvironmental enteric dysfunction (EED) is an asymptomatic intestinal disorder associated with growth impairment, delayed neurocognitive development, and impaired oral vaccine responses.
objectivesWe set out to develop and validate a histopathologic scoring system on duodenal biopsies from a cohort study of children with growth failure in Bangladesh, Pakistan, and Zambia ("EED") with reference to biopsies from United States children with no clinically reported histologic pathology (referred to hereafter as "normal") or celiac disease.
methodsFive gastrointestinal pathologists evaluated 745 hematoxylin and eosin slide images from 291 children with EED (mean age: 1.6 y) and 66 United States children (mean age: 6.8 y). Histomorphologic features (i.e., villus/crypt architecture, goblet cells, epithelial and lamina propria acute/chronic inflammation, Brunner's glands, Paneth cells, epithelial detachment, enterocyte injury, and foveolar metaplasia) were used to score each histopathologic slide. Generalized estimating equations were used to determine differences between EED, normal, and celiac disease, and receiver operating characteristic curves were used to assess predictive value.
resultsBiopsies from the duodenal bulb showed higher intramucosal Brunner's gland scores and lower intraepithelial lymphocyte scores than from the second or third parts of the duodenum (D2/3), so only D2/3 were included in the final analysis. Although 7 parameters differed significantly between EED and normal biopsies in regression models, only 5 (blunted villus architecture, increased intraepithelial lymphocytosis, goblet cell depletion, Paneth cell depletion, and reduced intramucosal Brunner's glands) were required to create a total score percentage (TSP-5) that correctly identified EED against normal biopsies (AUC: 0.992; 95% CI: 0.983, 0.998). Geographic comparisons showed more severe goblet cell depletion in Bangladesh and more marked intraepithelial lymphocytosis in Pakistan.
conclusionsThis scoring system involving 5 histologic parameters demonstrates very high discrimination between EED and normal biopsies, indicating that this scoring system can be applied with confidence to studies of intestinal biopsies in EED.
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