Decoding the Link Between Abnormal Gut Integrity and Reduced Linear Growth

By - Danone Nutricia Academy

This clinical summary explains and demonstrates the impact of environmental enteropathy on the reduced linear growth in preschool-age children.

Background

Stunting, a reduced linear growth, is a prevalent health problem in children globally. An estimated 32% of preschool-age children in developing countries have a height-for-age z score (HAZ) < -2. Reduced growth in children could be attributed to inadequate nutrition and acute infection. However, evidence suggests that 20% to 80% of seemingly healthy individuals present with asymptomatic environmental enteropathy (EE), affecting intestinal nutrient absorption. Thus, EE-induced reduced intestinal integrity may significantly contribute to malnutrition and poor growth.

Objective

The clinical trial investigated the association of EE to linear growth faltering in preschool children.

Table 1. The study design.

Study type	Single-center randomized control trial
Number of participants (N)	418 children
Study group	§Treatment group: 100 mL of water containing lactulose (5 g) and mannitol (1 g). (n=418)
Inclusion criteria	Children with- §2- to 5-year-old §Primary diet of maize and legumes §Documented history of growth monitoring every 2 to 3 months since birth
Exclusion criteria	Children with- §Any chronic debilitating illness (HIV infection or apparent congenital abnormalities) §Evidence of acute malnutrition §History or presence of diarrhea or hematochezia
Outcome measures	§The lactulose:mannitol ratio (L:M) §Urinary excretion of lactulose and mannitol (as a percentage of the dose administered) §Change in HAZ

HAZ: Height-for-age z score; HIV: Human immunodeficiency virus

Results

Table 1 shows how EE is associated with reduced linear growth in preschool-age children.

Characteristics	Mean ± SD (n%)
Height-for-age z score	-2.8±1.1
Change in weight-for-height, z score during three mo	-0.22±0.50
L:M ratio	0.2±0.2
L:M ratio >0.1	364 (87)
L:M ratio <0.1	54 (13)
L:M ratio 0.1-0.3	278 (67)
L:M ratio >0.3	86 (21)

87% of children had an L:M ratio >0.1, suggesting abnormal intestinal integrity.
Moreover, the trial results also showed that HAZ change was significantly associated with greater lactulose excretion but not with increased L:M (Figure 1).

Figure 1: Association between HAZ change and lactulose (%) excreted (A) and L:M (B).

denotes significance between parameters (p<0.05). HAZ: Height-for-age

Conclusion

This study demonstrated a distinct association between abnormal gut integrity and reduced linear growth in children. It can be explained by reduced nutrient absorption due to altered gut functioning leading to malnutrition and growth faltering.

References:

Weisz AJ, Manary MJ, Stephenson K, Agapova S, Manary FG, Thakwalakwa C, Shulman RJ, Manary MJ. Abnormal gut integrity is associated with reduced linear growth in rural Malawian children. Journal of pediatric gastroenterology and nutrition. 2012 Dec 1;55(6):747-50.

For the use of healthcare professionals only, not for distribution to general public.

CVM code: 1639650295079