Journal Article

EMERGING ENVIRONMENTAL FACTORS IN CHILD STUNTING GLOBALLY

Ly, Stephanie

2017

Overview

Background and objectives: Linear growth stunting in children is considered a form of chronic malnutrition. However, nutritional interventions have modest effects on height. The World Health Organization (WHO) estimated that 171 million, or 23.8% of the world's children are stunted. Emerging research has implicated environmental exposures leading to poor intestinal health, which reduces nutrient absorption and growth hormone production. The condition is known as environmental enteric dysfunction (EED) and is onset by constant exposure to fecal pathogens with a possible link to mycotoxins created by mold species. A systematic review was conducted on EED and mycotoxins on stunting to understand current knowledge and novel areas for research expansion. Methods: Specific search terms were used to conduct a systematic review in WHO Library and PubMed public databases. Next, duplicates were removed and remaining full-text articles were screened for eligibility. The criteria for article inclusion included: primary research, publication between 2011-2016, translatability to humans, and focus on the main topics of research interest. Results: A total of 302 articles were found after the initial search, 191 articles remained after duplicates, and 23 articles met eligibility criteria. Among the final articles included in the review, 12 focused on EED and 11 on mycotoxins in stunting. EED etiology was confirmed in constant exposure to fecal pathogens in diverse underserved populations. EED interventions used micronutrient supplements, autoimmune treatments, and behavioral trials. None of the interventions significantly alleviated EED or stunting. Among mycotoxin-focused articles, studies found that aflatoxin affected linear growth and mycotoxin prevalence was established in new populations. Mycotoxin interventions tested absorbents for food and replaced contaminated maize in households with both studies showing promising results. Pathways linking mycotoxin exposure to EED was also articulated in recent articles. Conclusions: Primary research conducted in the last five years have yielded modest impacts on stunting resolution but have expanded knowledge. Novel pathways between EED and mycotoxins have been implicated in linear growth and highlight the unmet need for continued etiologic and interventional research. A majority of studies was conducted in low- and middle-income country settings, which highlights the lack of access to adequate sanitation infrastructure and implications on stunting.

• Publisher: S. Karger AG
• Subject: Aflatoxins / Children / Children & youth / Corn / Dietary supplements / Environment / Environmental factors / Etiology / Exposure / Food contamination / Growth hormones / Households / Intestine / Malnutrition / Mycotoxins / Pathogens / Populations / Reproduction (copying) / Sanitation