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The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease
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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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Metadata
- 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.
- Venue
- Nature Reviews Gastroenterology & Hepatology
- Published
- 2012-12-11
- Volume
- 10
- Issue
- 4
- Pages
- 220-229
- ISSN
- 1759-5045 (ISSN-L)
- 1759-5053
- 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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