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12 November 2015

Environmental Enteric Dysfunction - What we know and what the participants said

Fifty experts drawn from diverse professional backgrounds attended a 3-day meeting at IAEA headquarters in Vienna recently to consider current knowledge on environmental enteric dysfunction (EED). The meeting also discussed interventions to prevent and treat EED and debated the role of stable isotope techniques in its diagnosis.

Stunting is known to emanate from long-term unfavourable conditions of nutrition and health but now poor sanitary conditions are also considered to be an important part of the problem. It is thought that living in poor sanitary conditions may lead to gut function disorder and chronic inflammation, referred to as EED.

The participants considered three important aspects of EED, namely: the pathways forming the basis for diagnosis and intervention, which include microbial translocation, gut inflammation, systemic inflammation, leakiness of the gut, altered gut microbiota, and nutrient malabsorption; the consequences of EED, which include retarded growth and vaccine non-responsiveness; and a range of interventions to prevent and treat EED from better sanitation practices to anti-inflammatory agents or antibiotics in the context of severe acute malnutrition and infection.

There was a consensus on the importance of developing tools to diagnose and characterise EED for better targeting of interventions in vulnerable populations. There was discussion for fostering the use of stable isotopes for assessments in three main areas: firstly, bacterial translocation; secondly, absorptive capacity of the gut/permeability; and thirdly, body composition as a proxy indicator of dietary quality and morbidity.

The meeting concluded that linking EED and stunting is appropriate and that several gaps exist that need attention such as the classification of EED, more longitudinal studies to better understand the underlying causes of EED, and the development of a low-cost, widely applicable test for epithelial integrity and function.

Several of the participants left their impressions of the event in the comments caught below.

Ross Butlet
Nancy Krebs
Christine Stewart
Alexander Loy
Mathias Altmann
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