Application of Stable Isotope Techniques in Environmental Enteric Dysfunction Assessment and Understanding its Impact on Child Growth

Retarded linear growth, widely referred to as stunting, is rampant in low and middle income countries, affecting a total of 161 million children under the age of five years; it develops in the first 1000 days of life, and becomes irreversible if no appropriate interventions are in place. Environmental Enteric Dysfunction (EED) is the presence of diffuse, upper small bowel villous atrophy accompanied by the presence of morphologic evidence of barrier disruption and inflammation. EED affects presumably 50-95% of all children under the age of 5 years in resource poor settings. Retarded growth, altered gut microbiota, and decreased vaccine responsiveness are considered the most important consequences of EED and are attributable to:  altered intestinal structure and function, defects in nutrient absorption, reduced growth hormone activity, altered host immunity and change in microbiota composition and diversity. Despite the significance of EED to infant and child nutrition and health, biomarkers and simple diagnostic techniques for the definition and classification of EED are lacking. This CRP aims to validate and apply a novel, non-invasive stable isotope technique (13C Sucrose Breath Test) to foster a better understanding of pathways underpinning EED and child growth. The key results of the CRP will be: 1) non-invasive 13C Sucrose Breath Test to diagnose EED and assess its effects on health; 2) improved technical capacity to diagnose and assess health of EED populations; 3) new data on the pathways underpinning the relationship between EED and child growth including dietary, mucosal integrity/permeability and nutrient and energy partitioning. The ultimate outcome will be a better understanding of the relationship between EED and child growth which will in turn contribute to the development of diagnostic tools for EED to facilitate its prevention, treatment and management to ensure good health.