Epidemiology
editEnvironmental enteropathy (EE) primarily affects children living in low- and middle-income countries (LMICs).[1] Children living in these countries were found to have enteric pathogens related to EE in their systems throughout much of their early childhoods.[1] Gastrointestinal abnormalities associated with EE are not congenital but are acquired during infancy and persist into adulthood.[2][3] Such abnormalities tend to develop after the first semester of life and are not present in newborns.[2]
Historically, environmental enteropathy has been prevalent in LMICs.[3] The geographic distribution of environmental enteropathy has shown an increase in incidence in such areas of poor sanitation and hygiene.[1] EE was first described in studies from the 1960-70s conducted in Asia, Africa, the Indian subcontinent, and Central America, during which it was discovered that signs of EE were high among otherwise healthy adults and children.[4] A study from 1971 following US Peace Corps volunteers is often cited as being the first study to demonstrate the ability to acquire and recover from EE according to the environment.[3] Participants experienced symptoms of chronic enteric infection during and shortly after returning from their placement in low- and middle-income countries.[1] Symptoms experienced by those abroad were resolved within one to two years after returning home to the US.[3] These results lead to the suggestion of the environment being a cause of EE, and a later study in Zambia was able to draw similar conclusions.[3] By the early 1990s, environmental enteropathy was found to be a widespread problem affecting infants and children.[3] Today, enteric infections and diarrheal diseases like environmental enteropathy account for 760,000 deaths per year worldwide, making EE the second leading cause of death in children under five years old.[4]
The exact causes and consequences of EE have been difficult to establish due, in part, to the lack of a clear disease definition.[1] However, risk factors do exist and they can be both environmental and nutritional.[1] Preexisting conditions such as micronutrient deficiencies, diarrheal diseases, and various chronic infections all serve as risk factors for EE.[1] Environmental conditions such as poor sanitation and unimproved water sources also contribute to the prevalence of EE.[1] Exposure to environmental microbial agents such as these is thought to be the most important factor in the development of EE.[2]
References
edit- ^ a b c d e f g h Tickell, Kirkby D.; Atlas, Hannah E.; Walson, Judd L. (2019-11-25). "Environmental enteric dysfunction: a review of potential mechanisms, consequences and management strategies". BMC Medicine. 17 (1): 181. doi:10.1186/s12916-019-1417-3. ISSN 1741-7015. PMC 6876067. PMID 31760941.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ a b c "Environmental enteric dysfunction and growth". Jornal de Pediatria. 95: 85–94. 2019-03-01. doi:10.1016/j.jped.2018.11.004. ISSN 0021-7557.
- ^ a b c d e f Crane, Rosie J.; Jones, Kelsey D. J.; Berkley, James A. (2015-3). "Environmental enteric dysfunction: An overview". Food and nutrition bulletin. 36 (1 0): S76–S87. ISSN 0379-5721. PMC 4472379. PMID 25902619.
{{cite journal}}: Check date values in:|date=(help) - ^ a b Syed, Sana; Ali, Asad; Duggan, Christopher (2016-7). "Environmental Enteric Dysfunction in Children: A Review". Journal of pediatric gastroenterology and nutrition. 63 (1): 6–14. doi:10.1097/MPG.0000000000001147. ISSN 0277-2116. PMC 4920693. PMID 26974416.
{{cite journal}}: Check date values in:|date=(help)