https://www.gastrojournal.org/article/0016-5085(84)90606-1/pdf

Intestinal flora in health and disease.

More than one-fifth of the world's population live in extreme poverty, where a lack of safe water and adequate sanitation enables high rates of enteric infections and diarrhoea to continue unabated. Although oral rehydration therapy has greatly reduced diarrhoea-associated mortality, enteric infections still persist, disrupting intestinal absorptive and barrier functions and resulting in up to 43% of stunted growth, affecting one-fifth of children worldwide and one-third of children in developing countries. Diarrhoea in children from impoverished areas during their first 2 years might cause, on average, an 8 cm growth shortfall and 10 IQ point decrement by the time they are 7-9 years old. A child's height at their second birthday is therefore the best predictor of cognitive development or 'human capital'. To this 'double burden' of diarrhoea and malnutrition, data now suggest that children with stunted growth and repeated gut infections are also at increased risk of developing obesity and its associated comorbidities, resulting in a 'triple burden' of the impoverished gut. Here, we Review the growing evidence for this triple burden and potential mechanisms and interventions that must be understood and applied to prevent the loss of human potential and unaffordable societal costs caused by these vicious cycles of poverty.

The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease

An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting with lifelong, possibly irrevocable consequences. Interventions to improve complementary feeding practices or the nutritional quality of complementary foods must take into consideration the contextual as well as proximal determinants of stunting. This review presents a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short- and long-term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education; society and culture; agriculture and food systems; and water, sanitation and environment. We argue that these community and societal conditions underlie infant and young child feeding practices, which are a central pillar to healthy growth and development, and can serve to either impede or enable progress. Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels.

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Contextualising complementary feeding in a broader framework for stunting prevention

Environmental enteropathy: critical implications of a poorly understood condition

Evidence that chronic alcohol exposure promotes intestinal oxidative stress, intestinal hyperpermeability and endotoxemia prior to development of alcoholic steatohepatitis in rats.

Ultrastructural changes in the small intestine induced by ethanol.

Recovery of small-intestinal structure and function after residence in the tropics. I. Studies in Peace Corps volunteers.

Forty-one former Peace Corps volunteers previously living in India or Pakistan for 18 to 24 months were studied after they had returned to the United States. Most noted cessation of diarrh...

Recovery of Small-Intestinal Structure and Function After Residence in the Tropics

Recovery of small-intestinal structure and function after residence in the tropics. II. Studies in Indians and Pakistanis living in New York City.

Misoprostol, a prostaglandin E analog, was recently approved for use in the prevention of nonsteroidal anti-inflammatory drug-induced ulcer disease. Its commonest side effects, diarrhea and abdomin...

Charles D. Gerson

Papers

Ultrastructural changes in the small intestine induced by ethanol.

Recovery of small-intestinal structure and function after residence in the tropics. I. Studies in Peace Corps volunteers.

Recovery of Small-Intestinal Structure and Function After Residence in the Tropics

Recovery of small-intestinal structure and function after residence in the tropics. II. Studies in Indians and Pakistanis living in New York City.

Life-Threatening Diarrhea after Short-Term Misoprostol Use in a Patient with Crohn Ileocolitis