Implications of acquired environmental enteric dysfunction for growth and stunting in infants and children living in low- and middle-income countries.
Implications of acquired environmental enteric dysfunction for growth and stunting in infants and children living in low- and middle-income countries.
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DOI：
10.1177/156482651303400308
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发表时间：
2013-09
影响因子：
1.9
通讯作者：
Brewer T
中科院分区：
文献类型：
--
作者：
Keusch GT;Rosenberg IH;Denno DM;Duggan C;Guerrant RL;Lavery JV;Tarr PI;Ward HD;Black RE;Nataro JP;Ryan ET;Bhutta ZA;Coovadia H;Lima A;Ramakrishna B;Zaidi AK;Burgess DC;Brewer T
在发展中国家，婴儿早期小肠功能的变化越来越多地被证明，可能伴随着大多数个体粘膜结构的改变，包括肠细胞体积减少和黏膜免疫激活和炎症的证据。这些变化似乎是环境中不确定因素的结果，可能是幼儿生长迟缓和发育迟缓的原因。由于这些原因，这一系列的发现被称为环境性肠病，或者如我们在这里提出的，环境性肠功能障碍。如果知道原因并有有效的干预措施，就可以制定和促进在出生前或可能在出生前进行干预的战略和政策，以防止随后的营养不良和复发性感染，众所周知，这两种疾病在临床下行过程中以周期性和协同的方式相互作用，往往以死亡告终。资源将以不同的方式调动和使用，重点将从治疗转向预防。为了朝着这个高度期望的方向前进，将需要在研究方面进行投资，以建立评估环境肠功能障碍的标准，确定其对生长迟缓和发育迟缓的预测价值，确定原因，并提出和测试潜在的干预措施。这些概念和工具是可用的。所需要的是决定沿着这条道路前进，以改善低收入国家婴儿和儿童的健康。
Changes in small bowel function early in infancy in developing countries are increasingly being demonstrated, probably accompanied by altered mucosal architecture in most individuals, including reduced enterocyte mass and evidence of immune activation and inflammation in the mucosa. These alterations appear to be the result of factors of uncertain nature in the environment, and may be a cause of growth faltering and stunting in young children. For these reasons, this constellation of findings is being referred to as environmental enteropathy, or as we propose herein, environmental enteric dysfunction. If the causes were known and effective interventions were available, strategies and policies to intervene at—or possibly before—birth could be developed and promoted in order to prevent subsequent malnutrition and recurrent infection, which are known to interact in a cyclical and synergistic manner in a downward clinical course often ending in death. Resources would be mobilized and applied differently, and the emphasis would change from treatment to prevention. In order to move in this highly desired direction, investments in research will be required to establish the criteria to assess environmental enteric dysfunction, determine its predictive value for growth faltering and stunting, identify the causes, and propose and test potential interventions. The concepts and tools are available. What is required is the decision to move forward along this pathway to better health for infants and children in low-income countries.