Association of intestinal pathogens with faecal markers of environmental enteric dysfunction among slum-dwelling children in the first 2 years of life in Bangladesh.

Mustafa Mahfuz,Md. Amran Gazi,Shah Mohammad Fahim,Subhasish Das,Tahmeed Ahmed

doi:10.1111/tmi.13141

Abstract

ObjectiveEnvironmental Enteric Dysfunction (EED) can be assessed by faecal biomarkers such as Myeloperoxidase (MPO), Neopterin (NEO) and Alpha‐1 anti‐trypsin (AAT). We aimed to test the association of intestinal pathogens with faecal markers of EED among slum‐dwelling children in first 2 years of life.MethodsThe MAL‐ED birth cohort data of Bangladesh site were used to conduct this analysis. Multivariable analyses using Generalized Estimating Equations (GEE) were performed to test the association between intestinal pathogens and faecal markers of EED.ResultsGiardiasis, ascariasis and trichuriasis were the most frequent parasitic infections and Campylobacter spp., Enteroaggregative Escherichia coli (EAEC) and Enterotoxigenic Escherichia coli (ETEC) were the common bacterial pathogens observed in stool samples of the children. Overall, 71%, 97% and 58% of stool samples were above values considered normal in non‐tropical settings for MPO, NEO and AAT respectively. Giardiasis was found to be significantly associated with MPO (Coefficient = 0.55; 95% CI = 0.15, 0.95; P‐value = 0.008) and AAT concentrations (Coefficient = 0.34; 95% CI = 0.04, 0.63; P‐value = 0.03). A significant association was found between trichuriasis and NEO (Coefficient = 0.90; 95% CI = 0.19, 1.61; P‐value = 0.01). Trichuriasis (Coefficient = 1.71; 95% CI = 0.32, 3.11; P‐value = 0.02) and giardiasis (Coefficient = 1.51; 95% CI = 0.79, 2.23; P‐value <0.001) were significantly associated with EED score. Children with EAEC had significantly higher MPO concentrations (Coefficient = 0.33; 95% CI = 0.06, 0.61; P‐value = 0.02).ConclusionThe study results imply the importance of intestinal pathogens in contributing to intestinal inflammation and increased intestinal permeability in young children.

Highlights

Environmental Enteric Dysfunction (EED) is a subclinical intestinal disorder highly prevalent in low and middle income countries [1, 2]
MPO and NEO are the specific markers of intestinal inflammation and Alpha-1 anti-trypsin (AAT) reflects enteric protein loss which is secondary to EED [12,13,14]
Association of intestinal pathogens with faecal markers of EED and EED score In multivariable analysis, giardiasis (Coefficient = 0.55; 95% confidence intervals (CIs) = 0.15, 0.95; P-value = 0.008) and Enteroaggregative Escherichia coli (EAEC) infection (Coefficient = 0.33; 95% CI = 0.06, 0.61; Pvalue = 0.02) were found to be significantly associated with faecal MPO concentrations after adjusting for sex, WAMI score, people sleeping per room, anaemia and ferritin

Summary

Introduction

Environmental Enteric Dysfunction (EED) is a subclinical intestinal disorder highly prevalent in low and middle income countries [1, 2]. EED refers to gut inflammation, increased intestinal permeability and reduced absorptive capacity in the small intestine [4]. These features are manifested by shortening of villi, crypt hyperplasia and infiltration of lymphocytes into the lamina propria in histopathology of biopsied specimens collected from the small intestine [9, 10]. MPO and NEO are the specific markers of intestinal inflammation and AAT reflects enteric protein loss which is secondary to EED [12,13,14]. It has already been posited that MPO, NEO and AAT can predict gut inflammation and increased intestinal permeability caused by EED [10, 15,16,17]

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Conclusion