Environmental Enteropathy, Micronutrient Adequacy and Length Velocity in Nepalese Children - the Mal-Ed Birth Cohort Study

Abstract

Background: Nutrient deficiencies limit the growth and turnover of intestinal mucosa, but studies assessing whether specific nutrients protect against or improve environmental enteric dysfunction (EED) are scarce. We aimed to investigate associations between nutrient intake and EED assessed by lactulose:mannitol ratio, anti-1-antitrypsin, myeloperoxidase and neopterin among children 9-24 months in Bhaktapur, Nepal. Methods: Among 231 included children, nutrient intake was assessed monthly by 24 hour recalls, and 3-month usual intake was estimated using Multiple Source Method. Associations between nutrient intake and L:M ratio (measured at 15 months) were assessed using multiple linear regression, while associations between nutrient intake and fecal markers (measured quarterly) were assessed using Generalized Estimating Equations (GEE) models. Results: We found that associations between nutrient intake from complementary food and lactulose-mannitol (L:M) ratio, alpha-1-antitrypsin (AAT), myeloperoxidase (MPO) and neopterin (NEO) were generally negative but weak. The only significant associations between nutrient intake (Potassium, Magnesium, Phosphorous, Folate and Vitamin C) and markers for intestinal inflammation were found for MPO. Conclusion: Negative but weak associations between nutrient intake and markers of intestinal inflammation were found. Significant associations between several nutrients and MPO might merit further investigation.