Environmental enteric dysfunction and child stunting

Budge, Sophie; Parker, Alison H; Hutchings, Paul T; Garbutt, Camila

doi:10.1093/nutrit/nuy068

Cited by 201Child Nutrition and Water AccessInfant Nutrition and HealthPublic Health and Nutrition

Environmental enteric dysfunction and child stunting

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Budge, Sophie, Parker, Alison H, Hutchings, Paul T, Garbutt, Camila·2019·Nutrition Reviews

DOI 10.1093/nutrit/nuy068PMC PMC6394759

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Abstract

In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide.

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EED and repeated diarrhoea cause nutrient malabsorption and, together with the intake of poor-quality food, result in growth retardation in the form of wasting and stunting.
“EED and repeated diarrhoea cause nutrient malabsorption and, together with the intake of poor-quality food, result in growth retardation in the form of wasting and stunting [76].”
From Intestinal Parasitic Infection and Nutritional Status in Children under Five Years Old: A Systematic Review (2022) · cites this paper as [76]
In “The missing piece of the stunting puzzle” (page unavailable), the paper describes malabsorption in EED and identifies food quality and quantity as relevant to preventing stunting. “Enteric infection and nutritional status” suggests that EED-related gut disturbances combined with limited diet contribute to stunting. The claim goes further than the paper by presenting repeated diarrhoea as a definite cause and adding wasting: the paper says diarrhoea’s causal role in stunting is uncertain, and the retrieved passages do not support a wasting outcome. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Linear growth occurs from the ages of 6 to 24 months; in this phase, demand for nutrients is high and if faced with a poor nutrient environment, children will be stunted.
“Linear growth occurs from the ages of 6 to 24 months. In this phase, demand for nutrients is high and if faced with a poor nutrient environment, children will be stunted [76].”
From Intestinal Parasitic Infection and Nutritional Status in Children under Five Years Old: A Systematic Review (2022) · cites this paper as [76]

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Background

Authors: Budge, S., Parker, A. H., Hutchings, P. T., & Garbutt, C.
Affiliations: Cranfield University (GB)
People in Need (CZ)
Corresponding author: Parker, Alison H
ORCID: Budge, Sophie
Parker, Alison H
Hutchings, Paul T
Garbutt, Camila
Venue: Nutrition Reviews
Publisher: Oxford University Press (OUP)
Published: 2019-02-07
Volume: 77
Issue: 4
Pages: 240-253
ISSN: 0029-6643 (ISSN-L)
1753-4887
DOI: 10.1093/nutrit/nuy068
PMC: PMC6394759
OpenAlex: W2912378060
Cited by: 201
References: 128
Citations by year: 2026: 18 · 2025: 30 · 2024: 32 · 2023: 39 · 2022: 23 · 2021: 26 · 2020: 24 · 2019: 9
FWCI: 1.89
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (vor, 1 d)
Locations: Nutrition Reviews (publishedVersion, cc-by-nc-nd)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
CERES (Cranfield University) (submittedVersion, cc-by-nc-nd)
Funders: Cranfield University and People in Need
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
Keywords: environmental enteric dysfunction, child stunting, intestinal inflammation, poor sanitation, water, sanitation and hygiene interventions, pathogen exposure, linear growth, infant nutrition, failure to thrive
MeSH terms: Child, Child, Preschool, Developing Countries, Diarrhea, Environment, Feeding Behavior, Growth Disorders, Humans, Hygiene, Infant, Nutritional Status, Sanitation

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Environmental enteric dysfunction and child stunting

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