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The contribution of environmental enteropathy to the global problem of micronutrient deficiency.

Authors
  • Kelly, Paul1, 2
  • 1 Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK.
  • 2 Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia. , (Zambia)
Type
Published Article
Journal
Proceedings of The Nutrition Society
Publisher
Cambridge University Press
Publication Date
Aug 01, 2021
Volume
80
Issue
3
Pages
303–310
Identifiers
DOI: 10.1017/S0029665121000549
PMID: 33663621
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Sometimes referred to as hidden hunger, micronutrient deficiencies persist on a global scale. For some micronutrients this appears to be due to inadequate intake, for others intake may not match increased requirements. However, for most micronutrient deficiencies there is uncertainty as to the dominant driver, and the question about the contribution of malabsorption is open. Environmental enteropathy (EE), formerly referred to as tropical enteropathy and also referred to as environmental enteric dysfunction, is an asymptomatic disorder of small intestinal structure and function which is very highly prevalent in many disadvantaged populations. Recent studies of the pathology and microbiology of this disorder suggest that it is driven by very high pathogen burdens in children and adults living in insanitary environments and is characterised by major derangements of the epithelial cells of the intestinal mucosa. Transcriptomic data suggest that it may lead to impaired digestion and absorption of macronutrients. Given the very high prevalence of EE, marginal malabsorption could have large impacts at population scales. However, the relative contributions of inadequate soil and crop micronutrient contents, inadequate intake, malabsorption and increased requirements are unknown. Malabsorption may compromise attempts to improve micronutrient status, but with the exception of zinc there is currently little evidence to confirm that malabsorption contributes to micronutrient deficiency. Much further research is required to understand the role of malabsorption in hidden hunger, especially in very disadvantaged populations where these deficiencies are most prevalent.

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