The effect of microbial exposure and environmental enteric dysfunction on child growth – evaluation of a combined nutrition and food hygiene intervention in Bangladesh

• Applicants: Professorin Sabine Gabrysch, Ph.D.; Dr. Georg Zeller
• Subject Area: Epidemiology and Medical Biometry/Statistics ; Parasitology and Biology of Tropical Infectious Disease Pathogens ; Public Health, Healthcare Research, Social and Occupational Medicine
• Term: from 2018 to 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 413269709

Worldwide, an estimated 155 million children under 5 years suffer from chronic undernutrition. Particularly during the first 1000 days of life, undernutrition can cause detrimental developmental consequences, like stunted physical growth (“stunting”), compromised immune function and impaired cognitive development, thereby preventing the children from reaching their full potential and productivity in adulthood. Underlying causes of undernutrition are manifold, but two main contributing factors are 1) insufficient intake of nutritious food, containing protein, essential fatty acids, vitamins and minerals, and 2) poor sanitation and food hygiene practices, leading to repeated enteric infections or a subclinical inflammatory condition of the gut, termed environmental enteric dysfunction. Most interventions addressing the problem of undernutrition are tackling the pathway of nutrient intake, yet nutrition-specific interventions alone have been shown to have only a small effect on stunting. In contrast, microbial contamination of food, although highly prevalent in low-income settings, has received comparatively little attention. Unhygienic preparation and feeding of contaminated food frequently puts children at risk of ingesting pathogenic bacteria and to develop intestinal infections, diarrhea, microbiota dysbiosis and environmental enteric dysfunction. Therefore, efforts should focus not only on ensuring that young children at risk of undernutrition receive a sufficient amount of nutritious food but also on ensuring this food is prepared hygienically in order to prevent microbial contamination. In the proposed study we want to evaluate the effect of a combined nutrition and food hygiene intervention on development of environmental enteric dysfunction in young children in rural Bangladesh and its subsequent impact on child growth and development. In addition to assessing whether the intervention has any effects, we will also investigate how exactly these are achieved. Therefore, we will study factors along the pathway of change from intervention to environmental enteric dysfunction development and growth outcome, including microbial contamination of complementary food, intestinal pathogen load, diarrheal episodes, and intestinal microbiota composition, as well as their interplay. The project findings will contribute to the development of sustainable combined nutrition and hygiene intervention approaches and policies to reduce environmental enteric dysfunction and undernutrition in children in Bangladesh and other low-income countries.

• DFG Programme: Research Grants
• International Connection: Bangladesh
• International Co-Applicant: Dr. Mahbubur Rahman