Abstract
Intestinal damage in malnutrition constitutes a threat to the survival of many thousands of children globally. We studied children in Lusaka, Zambia, with severe acute malnutrition (SAM) and persistent diarrhea using endoscopy, biopsy and analysis of markers and protective proteins in blood and intestinal secretions. We carried out parallel investigations in apparently healthy adults, and analyzed biomarkers only in apparently healthy children. Villus height and crypt depth did not differ in children with SAM and adult controls, but epithelial surface was reduced in children with SAM (median 445, interquartile range (IQR) 388, 562μm per 100μm muscularis mucosae) compared to adults (578, IQR 465,709; P=0.004). Histological lesions and disruptions of claudin-4 and E-cadherin were most pronounced in children with SAM. Circulating lipopolysaccharide, a marker of bacterial translocation, was higher in malnourished children (251, IQR 110,460EU/ml) than in healthy children (51, IQR 0,111; P=0.0001). Other translocation markers showed similar patterns. Anti-Deamidated Gliadin Peptide IgG concentrations, although within the normal range, were higher in children with SAM (median 2.7U/ml, IQR 1.5–8.6) than in adults (1.6, 1.4–2.1; P=0.005), and were inversely correlated with villus height (ρ=−0.79, n=13, P=0.001). Malnutrition enteropathy is associated with intestinal barrier failure and immune dysregulation.
Highlights
Malnutrition underlies 45% of child deaths in low- and middle-income countries (LMICs) (McDonald et al, 2013)
Children living in LMICs may have one or more enteropathies, with or without a contribution from HIV infection
We report a comparison of the pathology and severity of enteropathy in children with severe acute malnutrition and well children and adults living in a community where the prevalence of stunting is high and from which, historically, many admissions to the hospital malnutrition ward have originated
Summary
Malnutrition underlies 45% of child deaths in low- and middle-income countries (LMICs) (McDonald et al, 2013). Severe acute malnutrition (SAM) is characterized by low weight for height (wasting), with or without edema, and affects approximately 20 million children annually. While community management of acute malnutrition has transformed outcomes for children with uncomplicated SAM (Amadi et al, 2016; Collins et al, 2006), children with medical complications such as acute infections still require hospitalization. Stunting (i.e. poor linear growth) affects one-third of children in developing countries and underlies 14–17% of under-5 mortality (Olofin et al, 2013). Implementing the ten best evidence-based nutrition-specific interventions at 90% coverage would reduce stunting by only 20%, thereby achieving only half the World Health Assembly goal of a 40% reduction by 2025 (Bhutta et al, 2013)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
