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Review
. 2019 Apr 1;77(4):240-253.
doi: 10.1093/nutrit/nuy068.

Environmental enteric dysfunction and child stunting

Sophie Budge  1 , Alison H Parker  1 , Paul T Hutchings  1 , Camila Garbutt  2
Affiliations
Review

Environmental enteric dysfunction and child stunting

Sophie Budge et al. Nutr Rev. .

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.

Keywords: WASH; early child development; environmental enteric dysfunction; malnutrition; sanitation; stunting.

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Figures

Figure 1
Figure 1
Proposed causal pathway linking environmental enteric dysfunction with linear growth faltering.
Figure 2
Figure 2
The common pathways by which infants are exposed to, and ingest pathogens in the domestic environment. The dashed lines integrate the traditional ‘F diagram’ which do not relate specifically to infant behaviours. Adapted alongside the ‘F diagram’, as published by Wagner, E and Lanoix, J, 1958.
See this image and copyright information in PMC

References

    1. United Nations’ Children’s Fund, World Health Organization, World Bank. Joint Child Malnutrition Estimates—Levels and Trends. Geneva, Switzerland: World Health Organization, 2017. Available at: http://www.who.int/nutgrowthdb/estimates2016/en/. Accessed December 15, 2017.
    1. WHO Multicentre Growth Reference Study Group . WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva, Switzerland: World Health Organization, 2006.
    1. Stevens G, Finucane M, Paciorek C, et al. Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Lancet. 2012;380:824–834. - PMC - PubMed
    1. United Nations’ Children’s Fund. Malnutrition: current status and progress. 2017. Available at: https://data.unicef.org/topic/nutrition/malnutrition/#. Accessed December 15, 2017.
    1. Black R, Victora C, Walker S, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–451. - PubMed

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