Association of Fecal Markers of Environmental Enteric Dysfunction with Zinc and Iron Status among Children at First Two Years of Life in Bangladesh.

Mustafa Mahfuz,Tahmeed Ahmed,Md Amran Gazi,Subhasish Das,Kazi Istiaque Sanin,Shah Mohammad Fahim,M Munirul Islam

doi:10.4269/ajtmh.17-0985

Abstract

.Environmental enteric dysfunction (EED) causes gut inflammation and increased intestinal permeability leading to deficiencies in micronutrients such as zinc and iron. Fecal markers such as myeloperoxidase (MPO), neopterin (NEO), and alpha-1-anti-trypsin (AAT) can predict EED. The aim of this study was to examine the association between fecal markers of EED with zinc and iron status among children at first 2 years of life. Malnutrition and Enteric Disease Study Bangladeshi birth cohort data were used to conduct this analysis. Multivariable analyses using generalized estimating equations were performed to test the association between individual fecal markers with zinc or iron status of the children. A total of 265 children were enrolled in the study (male:female = 1:1). Of the 627 stool samples collected (N = 222 children), 535, 511, and 577 were accompanied by zinc, ferritin, and soluble transferrin receptor values, respectively. Median (interquartile range [IQR]) values of AAT, MPO, and NEO were 0.33 (0.18–0.62) mg/g, 3,895.42 (1,563.76–8,432.82) ng/mL, and 890.81 (331.57–2,089.04) nmol/L, respectively. Overall, 60%, 71%, and 97% of samples were above the values considered normal in nontropical settings for AAT, MPO, and NEO, respectively. High AAT levels were significantly associated with low ferritin values after adjusting for age and gender (coefficient = −5.85; 95% confidence interval = −11.23 to −0.47; P value = 0.03). No such association was found between AAT and plasma zinc status. Myeloperoxidase and NEO were not associated with plasma zinc or iron status. The study results imply the importance of enteric protein loss in contributing to reduced ferritin levels at first 2 years of life.

Highlights

Stunting or linear growth faltering is a global public health concern and highly prevalent in low- and middle-income countries
Environmental enteric dysfunction (EED) and zinc deficiency are considered as the key determinants of linear growth failure in early years of life.[5,6]
According to our study findings, high fecal levels of AAT were associated with decreased ferritin values among children aged less than 2 years living in a slum in Baunibadh area of Mirpur, Bangladesh

Summary

Introduction

Stunting or linear growth faltering (length-for-age z-score [LAZ] < −2) is a global public health concern and highly prevalent in low- and middle-income countries. More than a third of children aged less than 5 years in South Asia and Sub-Saharan Africa are stunted or short for their age.[1] Stunting implicates as great as 5-fold increased risk of mortality among under-5 children. It is even more perilous for the younger children aged less than 2 years.[2] The period encompassing first 2 years of life is eminent for growth and development. Environmental enteric dysfunction (EED) and zinc deficiency are considered as the key determinants of linear growth failure in early years of life.[5,6]

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Conclusion