The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease

Guerrant, Richard L.; DeBoer, Mark D.; Moore, Sean R.; Scharf, Rebecca J.; Lima, Aldo A. M.

doi:10.1038/nrgastro.2012.239

Cited by 606Child Nutrition and Water AccessViral gastroenteritis research and epidemiologyPublic Health and Nutrition

The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease

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Guerrant, Richard L., DeBoer, Mark D., Moore, Sean R., Scharf, Rebecca J., Lima, Aldo A. M.·2013·Nature Reviews Gastroenterology & Hepatology

DOI 10.1038/nrgastro.2012.239PMC PMC3617052

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Abstract

More than one-fifth of the world's population live in extreme poverty, where a lack of safe water and adequate sanitation enables high rates of enteric infections and diarrhoea to continue unabated. Although oral rehydration therapy has greatly reduced diarrhoea-associated mortality, enteric infections still persist, disrupting intestinal absorptive and barrier functions and resulting in up to 43% of stunted growth, affecting one-fifth of children worldwide and one-third of children in developing countries. Diarrhoea in children from impoverished areas during their first 2 years might cause, on average, an 8 cm growth shortfall and 10 IQ point decrement by the time they are 7-9 years old. A child's height at their second birthday is therefore the best predictor of cognitive development or 'human capital'. To this 'double burden' of diarrhoea and malnutrition, data now suggest that children with stunted growth and repeated gut infections are also at increased risk of developing obesity and its associated comorbidities, resulting in a 'triple burden' of the impoverished gut. Here, we Review the growing evidence for this triple burden and potential mechanisms and interventions that must be understood and applied to prevent the loss of human potential and unaffordable societal costs caused by these vicious cycles of poverty.

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Undernutrition can be a consequence of repeated bouts of diarrhoea.
“Undernutrition can be a consequence of repeated bouts of diarrhoea.5, 13”
From Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: a global analysis for selected adverse health outcomes (2023) · cites this paper as [13]

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Guerrant, R. L., Kosek, M. N., Moore, S. R., Lorntz, B., Brantley, R. K., & Lima, A. Â. M. (2002) · Archives of Medical Research · doi:10.1016/s0188-4409(02)00379-x · Cited by 178 · see citing works
Recent Advances in Understanding the Long-Term Sequelae of Childhood Infectious Diarrhea
Scharf, R. J., DeBoer, M. D., & Guerrant, R. L. (2014) · Current Infectious Disease Reports · doi:10.1007/s11908-014-0408-y · Cited by 30 · see citing works
Early childhood diarrhoeal diseases and cognition: are we missing the rest of the iceberg?
MacIntyre, J., McTaggart, J., Guerrant, R. L., & Goldfarb, D. A. (2014) · Paediatrics and International Child Health · doi:10.1179/2046905514y.0000000141 · Cited by 57 · see citing works
Interactions between intestinal pathogens, enteropathy and malnutrition in developing countries
Prendergast, A. J., & Kelly, P. M. (2016) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0000000000000261 · Cited by 105 · see citing works

Authors: Guerrant, R. L., DeBoer, M. D., Moore, S. R., Scharf, R. J., & Lima, A. A. M.
Affiliations: University of Virginia (US)
Cincinnati Children's Hospital Medical Center (US)
Corresponding author: Guerrant, Richard L.
ORCID: Guerrant, Richard L.
DeBoer, Mark D.
Moore, Sean R.
Scharf, Rebecca J.
Venue: Nature Reviews Gastroenterology & Hepatology
Publisher: Springer Science and Business Media LLC
Published: 2012-12-11
Volume: 10
Issue: 4
Pages: 220-229
ISSN: 1759-5045 (ISSN-L)
1759-5053
DOI: 10.1038/nrgastro.2012.239
PMC: PMC3617052
OpenAlex: W2034847662
Cited by: 604
References: 136
Citations by year: 2026: 43 · 2025: 45 · 2024: 32 · 2023: 60 · 2022: 47 · 2021: 69 · 2020: 51 · 2019: 62 · 2018: 53 · 2017: 41 · 2016: 38 · 2015: 32 · 2014: 22 · 2013: 8
FWCI: 2.42
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: www.springer.com/tdm (tdm)
Locations: Nature Reviews Gastroenterology & Hepatology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Allergy and Infectious Diseases (U01AI026512)
Fogarty International Center (K02TW008767, D43TW006578)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
Keywords: childhood diarrhea, gastrointestinal infections, stunting, malnutrition, obesity, chronic disease, intestinal barrier dysfunction, intestinal absorption, cognitive development, human capital, poverty, water and sanitation, oral rehydration therapy
MeSH terms: Child, Child, Preschool, Chronic Disease, Cognition Disorders, Crowding, Diarrhea, Growth Disorders, Humans, Infant, Infant, Newborn, Infections, Intestinal Diseases, Poverty, Risk Factors, Sanitation, Child Nutrition Disorders

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The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease

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